Chapter 7,10,22,5,6 Flashcards
Evidentialism
Framework for understanding how research evidence and patient concert, history, family, etc. are used in a decision making process by the clinicians to determine an EBP POC
Central themes of evidentialism
1) clinicians must find and now info upon which decisions are made
2) decisions are based on current evidence
5 underlying assumptions
1) decisions=justified if result from responsible behavior
2) external evidence isn’t always enough
3) as ex. evidence changes, the decision makers should too
4) clinical wisdom- decisions made from external evidence depend on validity, reliability, and applicability
5) belief without external evidence is unjustified
McCracken and Corrigan 3 skill sets
clinical, technical, organizational
Clinical skill set
knowledge, skills, experience related to direct experience with clients
Technical skill set
formulating questions, conducting an electronic search, evaluating validity and reliability
Organizational skill set
teamwork, organizational design and development, and leadership
Quality improvement
used to ID and resolve performance deficiencies, fixes something broken, compares current performance to a standard, focuses on outcomes in the delivery of care
Quality assurance
planned, systematic activities that assure quality requirements of a product/service are fulfilled (toaster warranty)
Quality control
observation techniques used to fulfill quality requirements (every toaster is up to the same requirements-are we doing what we are supposed to be doing)
Ellwood
Outcomes management-what is best for the patient and how do we get there
Ellwood’s priniciples
1) emphasize practice standards that providers can use to select interventions
2) measure patient functional status, well-being, and disease-specific clinical outcomes
3) Pool outcome data on a massive scale
4) Analyze and disseminate outcomes
What to find in a quality management department
incident reports, patient satisfaction scores, data collected for regulatory or accreditation bodies
what to find in a finance department
charges for tests, medications, equipment or supplies, patient days, readmission rates, patient demographics, patient diagnosis coding
what to find in human resources
staff turnover and education levels, hours by pay/labor category; contract labor use; provider skill mix, staffing ratios
what to find in clinical systems
will vary- at minimum diagnostic test results and pharmacy data
what to find in administration
patient complaints
what to find in EHR
patient-level info captured through documentation of clinical care
Instrument validity
is the instrument measuring what it is supposed to be measuring
instrument reliability
does the instrument measure the construct consistently every time it is used
Nominal
data sorted into categories using names- gender, presence or absence of a quality
Ordinal
data ranked in order
interval
numeric data with equal and consistent mathematical values separating each discrete measurement point with NO ABSOLUTE ZERO- Fahrenheit temp scale
Ratio
sama as interval but with an absolute zero- Kelvin
Scorecards
Show how indicators compare against each other. allows for observation of intended and unintended. within a hospital
Dashboards
Indicators focus on performance. Usually comparing a hospital to another
Core ethical principles of safety
nonmaleficence
core ethical principles of effectiveness
beneficence
core ethical principles of patient-centeredness
autonomy
core ethical principles of timeliness
beneficence and nonmaleficence
core ethical principles of equity
justice
core ethical principles of efficiency
beneficence and nonmaleficence
EBQI ethical dilemmas
1) attempts to improve quality for some that may cause harm to others
2) strategies intended to improve quality that waste scarce time/resources
3) activities declared to be quality improvement that may be more accurately described as clinical research
Case studies or Case reports
reports that describe the history of a single patient (or small group or patients) usually in the form of a story. focus on an aspect of a condition no control group -ranked lower(d) -no generalizations(d) -rare events(a) -hypothesis generation(a)
case-control
case and control group. start with outcome and explore risk factors/conditions that may have contributed to it
- quickly(a)
- efficient for rare outcomes(a)
- cannot directly obtain absolute risk(d)
cohort studies
treatment or condition followed over time for a presumed outcome
-disadvantage-large sample size, inefficient for rare outcomes, long periods of time, not as reliable as RCT
advantage-causation of a disease or to eval outcome of treatment when RCTs not possible
randomized controlled trials
compares effectiveness of different interventions
two groups-experimental and control
randomly assigned with no bias
narrative review
research review. discussion of an issue. supports author’s point of view
integrative review
summarizes other articles. no summary statistic due to limitations in studies found
meta-analysis
statistical approach to synthesizing results of multiple studies. Large sample size. Result is a summary statistic
systematic review
compilation of similar studies using a detailed rigorous appraisal method. Minimizes bias in summarizing research
prelim questions
purpose sample size valid and reliable analysis of data adverse effects/withdrawals results with previous research clinical implication
Internal validity
the extent to which it can be said the IV causes a change in the DV and the results are not due to other factors
external validity
the ability to generalize the findings from a study to the larger population from which the sample size was drawn
study reliability
if the study were repeated under the same circumstances, would the results be the same
study bias
anything that distorts study findings in a systematic way arising from the methodology of the study
selection bias
participants are selectively assigned to groups. RANDOMIZE
knowledge of who receives the intervention
can occur if subjects or researchers know subject group assignment. BLIND
gatekeeping
convenience sampling. when patients may be chosen because they are more likely to volunteer resulting in a sample not representative of the target population
measurement bias
can occur if instruments are incorrectly calibrated or if data collectors deviate from protocols
recall bias
can occur when subjects are asked to recall past actions or events
information bias
can occur in longitudinal cohort studies if participants know the subject of the study and act difference if they know that they are in the group that is being exposed
loss to follow up
attrition could occur due to unforeseen side effects of the intervention
contamination
can occur if intervention and control groups have interaction and information is shared
confounding variables
relationship between two variables is actually due to a third or unknown or unconsidered variable.
reliability 5 question
1) do the numbers add up
2) what is the magnitude of the effect
3) strength of association
4) what is the clinical significance
5) what is the precision of the measurement of effect
absolute risk reduction
risk of undesirable outcome is less for treatment than control group
absolute risk increase
when risk of an undesirable outcome is more for treatment than control group
relative risk
likelihood that outcome will occur in one group versus the other
odds ratio
odds of treatment group having the outcome
ethnography
the study of a social group’s culture through combining participant observation, in-depth interviews, and the collection of artifacts. do not aim at generalizable results
grounded theory
used to generate theory that is grounded in empirical data
phenomenology
the study of essence through descriptions of lived experiences
hermeneutics
philosophy, theories, practices of interpretation
narrative analysis
generates and interprets stories about life experiences in a way that allows understanding of interview data
content analysis
refers to breaking down data by coding, comparing, contrasting, and categorizing bits of info, then reconstituting them in some new forms, such as description, interpretation, theory
purposeful sampling
uses intentional selection of people or events in accordance with the needs of the study
theoretical sampling
form of purposeful sampling used in grounded theory
nominated/snowball
recruits participants with the help of informants that are already enrolled
volunteer/convenience sampling
obtains participants by solicitation or advertising for volunteers who meet the study criteria
lincoln and guba
how to appraise qualitative studies
credibility
demonstrated by accuracy and validity that is assured by thorough documentation. INTERNAL VALIDITY
transferability
demonstrated by info that is sufficient for a research consumer to determine whether findings are meaningful. EXTERNAL VALIDITY
dependability
if another researcher can expect similar findings. RELIABILITY
confirmability
findings and interpretations are grounded in the data. OBJECTIVITY
