Biostats and epi, public health, QI Flashcards
Difference between two groups is found
Alternative hypothesis
Or rejecting null hypothesis
Opposite of cross sectional study
Longitudinal (follows for period of time)
What is STROBE
Guidelines to help strengthen observational studies
Strengthening the Reporting of Observational Studies in Epidemiology
Case control vs cohort study
Case control - divides subjects based on outcome
Cohort - divides subjects based on initial exposure
When is meta analysis useful?
if published studies are underpowered or have conflicting results
Considered not human subject research
What kind of data is red-white-blue
Categorical (bins - no order)
What kind of data is the GCS or modified rankin scale
Ordinal (bins but definitive order)
What kind of data is numbers 1-100
Numerical or continuous
Type 1 error
Probability of aalse positive (or alpha)
P value
Type II error
Probability of false negative
Beta
Power formula
1 - beta
Test with normally distributed continuous data between 2 groups
Student T test
Test with normally distributed or continuous data between 3 or more groups
ANOVA
Test with ordinal data between 2 groups
Wilcoxon rank-sum test
Test with ordinal data between 3 or more groups
Kruskall-Wallis test
Test with categorical or binary data between groups
Chi-Square
Categorical or binary data if < 5 observations present
Fisher exact test
Regression and statistics linear vs logistic data
Linear: Continuous data
Logistics: Categorical data
Sensitivity formula
true positives / all tested
a / ( a + c)
Specificity formula
True negatives / all tested
d / (b + d)
PPD formula
true positives / all positives
a / (a + b)
NPV formula
true negatives / all negatives
d / (d + c)
Bonferroni correction
When comparing multiple things
0.05 divided by number of variables
Subgroup analysis
Rerunning analysis for smaller subset
(i.e women 18-25 year olds)
Careful for data mining
What is a multivariable analysis
Simulations analysis of multiple outcome variablesW
Who reviews interim data analysis
Data safety monitory board
Regionalization
Formation of a coordinated statewide or regional system of care
Categorization
Review against standards to classify the capabilities of the institution
Designation
Formal selection for patient referral and transfer
Minimum standards must be met
Usually by state
Why is self designation not ideal for a hospital? How it legal to block?
Inability to confirm categorization
Doesn’t count as anti-trust, If through valid regulatory agency
Most common cause of diversion
Lack of inpatient capability of a hospital
Syndromic surveillance
Monitoring for a constellation of symptoms prior to a defined diagnosis, utilized to improve speed of public health response during disease outbreak
3 essential components for EMS interface with public health
- Assessment
- Policy development
- Assurance
Quick access defibrillator studies
- Casino study
- American Airlines observational studies
- PAD trial
Flexner report of 1910
Led to?
Accused medical institutions of making lots of poorly trained doctors
Led to minimum stands for education
Crossing quality chasm stated
Redesign of healthcare
Safe, effective, patient centered, timely, efficient, equitable
Model for improvement came up with what
PDSA cycle
QA vs CQI
QA: emphasis on individuals performance, monitor and measure against a standard, reactive
QI: emphasis on process, systems approach, proactive
EMS at crossroads stated
National evidence based performance measures
NFPA 1710
Quality improvement program
NFPA standards for turnout time, response time and defibrillation?
1710
Turnout time - , 60 seconds
Response time - first response in 4 minutes, transport arrival within 8 minutes, ALS within 8 minutes
Defib - 50% of first shocks within 5 minutes
3 types of claims from QI
Defamation - provider claims performance review was slanderous
Antitrust/tortuous interference with business - loss of employment from discipline
Patient claim of negligent supervision - harmed by allowing provider to continue to practice
Level C recommendation
Fair evidence - clinical service benefits and risks are equivocal
