Book - Quality & Prevention

Question 1

Components of high quality care?

Answer 1

Access to care, adequate scientific knowledge, competent health care providers, separation of financial and clinical decision, and organization of health care institutions to maximize quality

Question 2

Components: Adequate scientific knowledge?

Answer 2

Need to distinguish between effective and ineffective/harmful care for appropriate standard of care

Question 3

Components: Separation of financial and clinical decisions?

Answer 3

Physician motivations should not be related to financial considerations (can lead to waste OR inadequate care)

Question 4

Proposals for improving quality?

Answer 4

Clinical practice guidelines, continuous quality improvement, EMR, financially neutral clinical decision making, measuring practice patterns, pay for performance, pay for reporting, public quality reporting, traditional quality assurance

Question 5

Proposals: Traditional quality assurance?

Answer 5

Proper licensure, accreditation, peer review (currently, NO requirement of period reexaminations for licensing)

Question 6

Proposals: Clinical practice guidelines?

Answer 6

Agency for Healthcare Research Quality (AHRQ) gives specific recommendations on how to treat clinical conditions (although some physician/pharma interests may be against this, and recommendations aren’t applicable to all)

Question 7

Proposals: Measuring practice patterns?

Answer 7

Process (types of services delivered), outcome, and structure….get feedback on this information

Question 8

Proposals: Continuous quality improvement?

Answer 8

Collaborate with interdisciplinary teams to improve institutions (currently only a small part of improvement)

Question 9

Proposals: EMR (3 benefits)?

Answer 9

1) Offers ways to monitor process/outcome for entire populations 2) Can generate reminder prompts for physicians and patients 3) Can regulated incorrect doses or medications likely to interact

Question 10

Negative side effects of malpractice?

Answer 10

1) System assumes punishment is reasonable method for improving quality 2) Based on assumption that trial by jury is best method to determine negligence 3) people with lower incomes usually receive smaller awards, so less attractive to file suit

Question 11

Malpractice reform options? (4)

Answer 11

Tort reform (caps on damages and lawyer fees), alternative dispute resolution (handle shit outside of court), no-fault reform (damages to injured patient regardless of negligence….create incentives for institutions to improve quality of care)

Question 12

Primary v. Secondary prevention?

Answer 12

Primary: seeks to avert the occurrence of disease or injury. Secondary: Early detection of a disease process and intervention to reverse or retard the condition from progressing

Question 13

2 examples of primary prevention?

Answer 13

Immunization, taxes on cigarette sales

Question 14

3 prevention strategies?

Answer 14

Improve standard of living, PH interventions to reduce illness incidence (water purification, tobacco tax), and preventive medical care

Question 15

Chronic disease prevention - 2 levels?

Answer 15

Individual, population

Question 16

Individual chronic disease prevention? Issues?

Answer 16

Medical model: identify high-risk individuals and provide them counseling. It’s like having blinders on (May target interventions at the wrong individuals)

Question 17

Population chronic disease prevention?

Answer 17

Reduce disease in the population as a whole through mass education campaigns, labeling of food, etc (this can be done by targeting risk factors)

Question 18

What’s more effective, primary prevention using PH measures or using medical care?

Answer 18

PH measures is far more cost-effective than primary prevention through medical care