Ch 5,6,8 Flashcards
HRSA
HC
Health resources and services administration
health center
This is a government agency within the US dept of health and human services that supports easy access to care for US residents though community-based, patient directed (51% of the governing board members must be patients of the health center), federally funded centers
HRSA
There are criteria that must be met to be designated as a HC:
- Be located in or provide services to high need communities-those designated by the govt as medically underserved
- Provide primary care and promote access to care that exceeds access previously offered through supportive services
- Provide services with fees charged on the basis of ability to pay
What is the scope of health center services?
Primary care
Dental care
Mental health
Substance abuse service
What percentage of HC patients are of a racial or ethnic background?
36% and 40% are uninsured
How is health care spending often described?
National health expenditure
What percentage of our GDP was health care spending in 1960?
5.2%
These are estimates of annual spending on health services, healthcare supplies, and research and construction activities related to health
National health expenditures or nation health spending
What factors have led to increased costs of healthcare spending?
- Curing versus maintaining wellness
- Technology
- Inefficiency of third party payer system
- Increase in elderly
- Waste and abuse within the system
- Inflation
- Recent recession and recovery
- Defensive medicine
Two general types of insurance:
Private and public
These are organizations that seek to apply the components of managed care to a population in the hope of providing high quality care at a lower cost than that incurred by the provision of fee for service care:
Managed care organizations (MCOs)
This is a care model that is characterized by a designated provider network, standardized review and quality improvement measures, an emphasis on preventative rather than acute care and financial incentives for doctors and patients to reduce unnecessary medical care use
Managed care
This is the amount an enrollee must pay to join the managed care plan. It serves as a membership fee and is typically adjusted annually
Premium
33% of funding sources for medical expenditures comes from?
Managed care organizations
These account of 52% of the funding sources for medical expenditures?
Public health insurance plans
This is the amount an insured patient must pay out of pocket for his medical care per year before the insurance plan covers the costs?
Deductible
Medicare part a covers what?
Hospitals, nursing homes, hospice care and some home health services
Medicare part b covers?
Supplemental portion that covers physician services and outpatient care not covered by part A
What services are not covered by medicare a or b?
Vision care, glasses, dentures, and hearing aides
How is the federal funding determined for medicaid?
On the basis of the state’s per capita income
A calculation reflecting a set of federal government guidelines related to income that is based on the cost of living
Federal poverty level
This is a fixed fee for each patient
Capitation
A fee agreed on between an insurance plan and physicians to provide medical services at a lower cost than is common for the area in exchange for access to the insurance plan’s pool of patient’s
Discounted fee for service
These are primary care providers in managed care who manage routine services and referrals for higher level care or speciality services
Gatekeepers
These are services that enhance access to medical care (transportation, interpretation, education, community outreach)
Enabling services
This is the least popular source of funding for LTC because of the high cost of premiums and its limited coverage
Private insurance
These are defined by the institute of medicine, “providers that by mandate or mission organize and deliver a significant level of health care and other health related services to the uninsured, medicaid, and other vulnerable patients
Safety net providers
6 basic activities of ADL’s:
Eating Bathing Dressing Toileting Transferring Maintaining bladder and bowel control
This measures an individuals ability to perform activities that are necessary to live independently in non institutional settings: such as driving a car, shopping, preparing meals and performing light housework
Instrumental activities of daily living
This is achieved through control of supply, price, and utilization
Regulation based cost containment
____ and colleagues in 2010 conducted a survey on leadership representatives of key stakeholder groups about workforce policies to examine perceptions on nurse workforce issues. The discovered that stakeholders should focus on the current lack of effective policy advocacy and leadership to advance nurse workforce issues on the national health agenda and in the medica
Donelan
These are health and safety standards defined by CMS as the minimum requirements that hospitals and medical centers must meet to be eligible to serve publicly insured patients
Conditions of participation
These are drug patent settlements where a drug company that has a brand name drug on the market pays a competitor intending to sell a generic version of the drug to delay bringing the lower cost drug to the market
Pay for delay
What are the top 3 speciality physician shortages?
General practitioners
General internal medicine
Psychiatric physicians
What are the 4 most commonly needed allied health professionals:
Nurses
PT
Pharmacists
OT
Macdowel and colleagues conducted survey on shortages in the healthcare system and identified four recruitment and retention factors significantly correlated with the reported primary care physician shortage:
- Healthcare major part of local economy
- Community is a good place for family
- Doctors are well respected and supported
- People in the community are friendly and supportive of each other
What is the primary goal of health policy?
Access to care to serve the most needy and underserved populations
What are the aims of informed consent?
- Respect and promote the autonomy of patients and research participants
- Protect patients and research participants from potential harm
The ability to fulfill the goals of informed consent depends on the presence of three basic components:
- Prerequisites including competence and voluntariness
- Clear and truthful information
- Free and voluntary enrollment, including the opportunity to withdraw consent without any impact on the quality of treatment received by the patient
When was emtala passed?
1986
What challenges do HC’s face?
Economic slowdown Demographic trends Shifting disease burden Increased complexity of healthcare system Workforce shortages Rapid rate of technology innovation
This is the convergence of health risks:
Vulnerability
Health risks consist of three characteristics at the individual and ecological levels:
Predisposing
Enabling
Need
These charactieristics describe the propensity of individuals to use services: demographics, social structures, and health beliefs live here
Predisposing characteristics
These are characteristics available to individuals and families for the use of services, the attributes of the surrounding community or region that affect the availability of healthcare services
Enabling characteristics
These are specific illnesses or health needs that drive the receipt of healthcare
Need factors
How much of the population is made up of racial or ethnic minorities?
34%
RSC is a usual place where or a usual provider from whom an individual received healthcare services
Regular source of care
These are efforts by healthcare organizations and providers to increase understanding and produce effective interventions for patients by taking into account patients cultural and linguistic characteristics
Culturally appropriate services
What are the factors contributing to the lack of RSC: (hispanic adults least likely to have one followed by America indians)
- Absence of health insurance coverage
- Low family income
- Language other than english spoken in the house
Who has the highest smoking prevalence among populations?
Blacks and american indians
OMH
Office of minority health
IHS
Indian health services
What percentage of the population is covered by federal programs like medicare and medicaid and chip
40%
This has been credited with improving the health status of undocumented children and reducing preventable hospitalizations
CHIs (children’s health initiatives in california)
This has been shown to have a greater impact on access to healthcare than race and ethnicity
Socioeconomic status
This is the only federal program that has a focus on investing in increasing the education level of individuals an often overlooked contributor to SES disparities in healthcare
Head start
This is a program in south carolina that is a public-private nonprofit partnership that offers free or low cost primary care, free prescription services, and free pediatric dental care to low income people without health insurance
Welvista program
This local initiative targeting those without insurance is in kansas city
Telekids
This was funded by robert wood johnson foundation and is one example of privately funded programs addressing SES disparities, through which undergraduate students volunteer in community clinics and connect patients with local health resources.
Project health design
For the elderly the concerns about primary care and health policy broadly revolve around the following:
Cost containment
Reforming health system to better serve a new, large generation of the elderly
Increasing quality of life as far as possible into old age
High disease burden means?
Two or more diseases
Chronic conditions means:
Five or more illnesses
Bodenheimer, chen, and bennett note that the most proactive ways to raise the quality of life for the elderly are to:
- Provide effective and low cost preventive treatments designed to lower risks factors for future adverse health outcomes
- Provide such treatments throughout the patients life
The burden of chronic illness is borne both by the _____, who experience frustration, high costs, and negative health outcomes, and by the _______ _______ which is often unable to provide appropriate, effective, and efficient care
Patient, healthcare system
This is a process by which a person or an idea is pushed aside n favor of another. This type of subject typically receives few resources and little attention
Marginalization
They tend to live longer, report more physically and mentally unhealthy days each month and have higher rates of chronic conditions in old age than men
Women
DALY: a measure of the loss of healthy life. This measurement is intended to capture the economic, social, and functional realities that a person with a disability will face and the corresponding loss in health status and quality of life
Disability adjusted life year
This is the m out documented risk for asthma, obesity, and adhd in children.
Maternal cigarette smoking
Who said that barriers that disabled patients confront represent quality problems and also heighten patients sense of stigmatization, disenfranchisement, and demoralization
Kirschner, breslin, and iezzoni
Who is one of the most marginalized groups in society?
The homeless
____ percent of residents will bear at least one occurrence of homelessness in their lives
7
Homeless and _____ unstable people are subject to much higher resource competition than most of the general population, and health issues that would be considered by others absolutely necessary to resolve may be sidelined by the homeless in favor of basic need,s such as foods and shelter
Housing
Up to _____% of the homeless population has a chronic mental health disorder or abuses drugs or alcohol
75
This homeless program is a leading outreach program that works to integrate care across the medical spectrum and housing situations to provide continuous services and preventive care
The boston health care for the homeless
When were the first AIDS cases identified?
1981
44% of this population group account for new hiv infections each year, and this population group accounts for 61% of new hiv infections every year.
Blacks, gay men
The barriers that inhibit hiv positive people from accessing lifesaving medications are significant:
The lifetime healthcare costs is one major issue
Assuming there is access to care the average length of lifespan post diagnosis with hiv is?
24.2 years
Obama’s national strategy for the aids strategy is hailed as the most comprehensive federal response to the domestic hiv epidemic to date sets three targeted goals for the country to achieve in the next ten years:
- Reduce new infections
- Improve access to care and outcomes
- Reduce health disparities
HPR
Health policy research
This is the process of scientific investigation that applies to various heal related and social science methodologies to formulate and evaluate health policies.
Health policy research (HPR)
What is the goal of HPR?
To improve the health of populations through needs assessment, policy, and program development, implementation, and evaluation
How is health policy research different from health policy analysis?
HPR tends to be conducted in a rigorous and systemic fashion, whereas policy analysis is time sensitive and relies on existing and current information
This is a systematic approach by high to assess problems and guide decision making.
Policy analysis
What do policy analysts help do?
Planning, budgeting, program evaluation, program design, program management, public relations, and other functions
Policy analysts follow a five step framework to assess problems:
- Establish the context and goals for a particular issue
- Identifying alternative approaches in addressing the issue
- Evaluating alternative and predicting consequences
- Valuing the outcomes
- Making a choice
There are five main attributes that characterize health policy research:
- Its nature as an applied field
- Ethics framework
- The multidisciplinary input it enjoys
- Its basis in science
- Its focus on population
Health policy research aims to address problems related to?
Specific populations like pregnant women, the elderly, or migrants and to enhance health interventions at the local, national, and international levels
Is the objective of researchers and policy makers always complementary?
No.
When does HPR come into play?
Often comes into play as the life of a policy begins, at policy formulation stage… a window of opportunity must exist for a policy to be fully developed
When does the window of opportunity open for HPR and policy to occur?
When there is favorable confluence of problems, possible solutions, and political circumstances
Policy process is a ______ cycle that is constantly informed by policy research
Feedback
This is a committee that examines the ethical implications of research to protect study subjects from physical or psychological harm
Institutional review board (IRB)
_____ standards dictate the proper conduct of research, including accommodation of the interests of research subjects.
Ethical
Throughout the duration of the study, the _____ of subjects should be protected through _____ or _______
Privacy, anonymity, confidentiality
The ______ sciences include the study of biological determinants, risk factors, and consequences of health processes, as well as methods and techniques to characterize such phenomena to contribute to the understanding o human populations
Biological
Theories from the ____ sciences and methodologies used in empirical research can provide guidance for HPR and include problem conceptualization, data collection, and analysis and interpretation
Social
This is the gold standard for scientific research?
Randomized controlled trail
In this trial the research subjects are randomly assigned to an experimental group or a control group
Randomized controlled trial
Why is the randomized controlled trial incompatible with HPR?
Researchers must consider determinants of health ad environmental factors beyond those captured under strict experimental conditions
Because of the ethical standards of HPR researchers typically use ___-____ designs, cohort studies, longitudinal analyses, survey analyses, and multidisciplinary approaches
Quasi-experimental
HPR focuses on the ____ rather than the individual
Population
HPR or analysis can be undertaken in a number of ways, the most widely used approach is the _____ model.
Rationalist
What are two types of execution errors that prevent successful completion of a study?
Writing an untestable hypothesis and securing an inadequate sample
The process of health policy analysis under rationalist method:
- Define the problem
- Determine evaluation criteria
- ID alternative policies
- Evaluate alternate policies
- Select the preferred policy
- Implement the preferred policy
Steps in conducting HPR:
- Conceptualization
- Groundwork
- Methods
- Design
- Sampling
- Measurement
- Data collection
- Data processing
- Data analysis
- Application
The conceptualization phase completes the development of a _____ framework, which is a preliminary model of the problem under study that depicts relationships among critical variables of interest and between variables and concepts of interest
Conceptual
This is a critical step within the conceptualization component, it informs researchers about the current state of the study on the topic as well as the existing limitations in the body of research
Conducting a literature review
These help facilitate the identification of theories and provide guidance in the formulation of hypotheses to be tested.
Literature reviews
In the groundwork stage the researcher does the following:
- Identifies relevant date sources
- Explores potential funding
- Develops research plan or proposal by which to obtain funding
- Makes organizational and administrative preparations to carry out the research
Those engaged in policy research used a range of data types:
Quantitative
Qualitative
Experimental
Descriptive data
What are the three categories of research methods?
Exploratory
Descriptive
Explanatory
These research methods are used to learn more about a little known topic or to test new research methods and examples are case studies or focus groups
Exploratory
These research methods are used to investigate study characteristics among subjects an example is the administration and analysis of survey data.
Descriptive research
Why are descriptive research methods difficult to conduct?
They are expensive to conduct and often require large sample sizes
This research method includes experimental studies and is considered the gold standard among research study methods, as well as case control studies and longitudinal research. They are the most rigorous in design, so findings have the greatest level of generalizability compared with other methods and it can be expensive and requires large sample sizes and complex statistical analysis
Explanatory research method
research design addresses the planning of scientific inquiry by:
Anticipate the stages of the project and choosing the method
Identify the unit of analysis and variables to be measured
Establishing procedures for data collection
Devising an analysis strategy
There are four types of sampling methods, often referred to as probability sampling designs because each subject in a sampling frame has a known probability of being selected for the sample, incorporating varying degrees of random selection:
Simple random sampling
Systematic sampling
Cluster sampling
Stratified sampling
This is the most basic sampling method in which every subject is the sampling frame has an equal probability of being selected
Simple random sampling
This sampling method is a bit more complicated in every kth subject from the sampling frame is selected (every 5th subject is selected from the sampling frame). The interval between selected subjects (k) is chosen by the researcher
Systematic sampling
______ selection are methods by which subjects from a sampling frame are randomly selected to create representative samples
Random
This involves the distribution of subjects in the sampling frame into herteogeneous clusters, which are then randomly selected to comprise a sample of clusters. These can be cost effective way to conduct research over a broad geographic area
Cluster sampling
This is similar to cluster sampling in that subjects from the sampling frame are divided into groups, however these groups (known as strata) are homogenous this method is chosen to ensure the sample is a representative of the population about which a researcher hopes to draw inferences in terms of charateristics of interest
Stratified sampling
Give an example of nonprobability sampling methods: the probability of subject selection in a sample is unknown when these methods are used
Convenience sampling, quota sampling, purposive sampling, and snowball sampling
This is the extent to which results are similar if the measurement tool is reapplied in a consistent way
Measurement reliability
This is the extent to which the measurement tool accurately measures the intended concepts
Measurement validity
There are two categories of data for HPR:
Primary sources and existing sources
What are two primary data collection tools used?
Interviews
Administration of questionnaires
Why are existing data or secondary data widely used in HPR?
They tend to be more generalized and are more efficient in terms of saving time and cost than are primary data
What can be the most satisfying step in the research process?
Applying research findings to scientific theory and policy formulation
Communicating HPR has the potential for multiple audience types, there are three potential groups:
Research community
Stakeholders
The public
What is the most common way to communicating results to the scientific community?
Publishing an article on the research in a peer reviewed scientific journal
Or, professional conferences
Or working papers and monographs
If stakeholders are the audience, investigators cannot?
Assume any prior knowledge of the subject and terminology
When the intended audience is the general public, investigators can rely on?
Mass media to publicize significant research findings
What are the barriers to the implementation of research in policy and some ways to overcome these barriers?
Relevance Type of study Priorities Timetable Communication Scope Values Leadership Rapport Skills Subject matter Methodology Statistics Computer application software Writing Public relations
