CHIA A6-9

Question 1

The essential components of a model of care include the following (9)

Answer 1

• Scope and context. To and by whom will the model be applied? What are the characteristics of the recipients that affect how care could and should be delivered? What is driving care needs?
• Aims. What are the specific objectives? How do they relate to the needs and expectations of the target group(s) and the standards and cultures of the service deliverers?
• Guiding principles. What fundamental tenets guide the development and implementation of the model?
• Standards and constraints. What levels must the model meet? What operational realities will it face? How will compromises be dealt with?
• The rationale for the model. What are the underlying logic and evidence bases?
• Processes and workflows. The level of detail required depends on the context. A model of care can be articulated for any level from a country to a highly specified small group of patients.
• Measures. Health informaticians should ensure measures are built into the model that will assist in determining and monitoring its relevance, effectiveness, efficiency and sustainability. Ultimately it must be possible to determine whether or not the model works for patients, care providers and the broader system – for example, using the quadruple bottom line (see Chapter F.4).
• Resourcing. Can existing resources meet the needs of the model? Can resourcing gaps be filled?
• Governance. Who governs clinically and managerially, and how? How is the model continuously monitored, benchmarked and improved? How are issues dealt with?

Question 2

Many continuity of care models are based on Wagner’s chronic disease management model

Answer 2

people with chronic disease require regular interactions with their caregivers, focusing on function and preventing exacerbations and complications. This includes systematic assessments, attention to treatment guidelines, and behaviourally sophisticated support for the patient’s role as a self-manager. Furthermore, these interactions must be linked through time by clinically relevant information systems and continuing follow-up initiated by the medical practice

Question 3

Name 4 care delivery models

Answer 3

Continuity of Care
Shared Care
Care coordination/Integreated care
Pareticipatory health

Question 4

Derfine Shared Care

Answer 4

In shared‐care models, responsibility for the patient is shared between different healthcare professionals such as an obstetrician, midwife, GP, and oncologist.
A single provider could deliver continuity of care over time. However, by definition, shared care involves at least two service providers.
Shared care models ensure coordination, coherence and continuity of care when more than one provider is required. They should lead to pooling expertise and enhanced creativity in problem-solving, ultimately improving patient care.

Question 5

Who does the fragmented Australian healthcare system cause most harm to

Answer 5

Along with many others, the Australian health system is often described as ‘fragmented’. Poorly coordinated is another way of saying this. Poor care coordination most acutely affects people with complex bio-psychosocial needs, frail people, and people with multiple long-term conditions (Lloyd et al., 2017).

Question 6

define public health

Answer 6

the art and science of preventing disease, prolonging life and promoting health through the organised efforts of society” (WHO, n.d-2). The Public Health Association of Australia (PHAA) describes it as “an interdisciplinary approach to health which focuses on population-wide programs to prevent rather than cure disease and illness” (PHAA, n.d.).

Question 7

Stratergy for public health - Create safer environment

Answer 7

Creating safer environments (health protection).
• Primarily regulatory: air and water quality, occupational health and safety, food handling and manufacture.
• Road safety.
• Vector eradication.

OHS, food safety, OH&S

Question 8

Stratergy for public health - Reducing risks of transmission

Answer 8

Reducing risks of transmission (health protection/ prevention).
• Immunisation (supported by compulsion, e.g., school entry certificates or reminder systems).
• Quarantine, school exclusion.
• Contact tracing.
• Reducing risky behaviours.
• Outbreak investigations.

C19 response,. childhood vaccination

Question 9

Stratergy for public health - Identifying disease early

Answer 9

Identifying disease early (prevention).
• Screening to identify at-risk individuals:
o To reduce the incidence of a condition (primary prevention).
o To identify people with an early stage of the disease.
o To interfere in its early history, thereby preventing the full manifestation of the condition (secondary prevention).

Cancer screening (cervical, bowel, breast)

Question 10

Stratergy for public health - Encouraging healthy behaviours

Answer 10

Encouraging healthy behaviours (health promotion).
• Advertising regulation and prohibition.
• Price and tax strategies.
• Campaigns with or without support groups (smoking, alcohol, exercise).
• Food manufacturing (sugar content and labelling).
• Legislative and regulatory interventions (regulating smoking places).

QUIT smoking, slip slop slap

Question 11

Stratergy for public health - Building healthier communities

Answer 11

Building healthier communities (health promotion).
• Community development.
• Social support initiatives.
• Developing social capital.

Communiyt, political, health policy involvement

Question 12

Stratergy for public health - Enabling function

Answer 12

Enabling function (infrastructure).
• Information and data development and dissemination.
• Workforce development.
• Research.

AIR, Better health channel

Question 13

epidemiology -define population at risk

Answer 13

The population at risk comprises the number of potentially susceptible people to the conditions or events under consideration – i.e., who share a characteristic that causes them to be vulnerable

Question 14

epidemiology -define Incidence

Answer 14

Incidence of a condition is the rate of occurrence of new cases arising in a given period in a specified population at risk. It provides a measure of the risk of the condition or the probability of developing the condition during the specified period.
The numerator is the number of new events in a specified period, while the denominator is the sum of all the disease-free person-time periods over the same period of data collection. Incidence must always include a unit of time.

Question 15

epidemiology -define prevalence

Answer 15

Prevalence is the frequency of existing cases in a specified population at risk at a given point in time – i.e., it includes all cases, both new and existing. Accordingly, it reflects both the incidence and the duration of illness. High prevalence of a disease might reflect high incidence and/or prolonged survival without a cure. Low prevalence might indicate low incidence, a rapidly fatal process, or rapid recovery.
Prevalence is often expressed as cases per 100 (percentage) or per 1,000 population.

Question 16

epidemiology -define severity

Answer 16

o Case fatality is the proportion of cases with the specified condition who die within a specified time, i.e., the number who die within a given period divided by the total number of diagnosed cases during the same period. It is usually expressed as a percentage.
o Average duration is the total number of years of the condition divided by the number of cases.

Question 17

epidemiology - exlpain types of death rates commonly used

Answer 17

Crude, Age-specifdic, Infant mortality (<1), Child mortality (<5)

Question 18

Epidemiology - Define DALY

Answer 18

Disability-adjusted life years (DALYs) are composite measures used to assess and compare the fatal and non-fatal effects of different diseases and injuries on population groups. One DALY is one year of ‘healthy life’ lost due to premature death, prolonged illness or disability, or a combination of these factors. The more DALYs, the greater the burden of disease.

Question 19

Epidemiology - Define comparison of absolute and relative occurrence

Answer 19

Absolute comparison measures include the following:
o Risk difference (excess risk) is the difference in occurrence rates between exposed and unexposed groups in the population. It is the calculated level of risk in the exposed group minus the estimated level of risk in the unexposed group but is often expressed in terms of 1,000 or 100,000 person-years.
o Exposed attributable fraction (also known as exposed aetiological fraction) is the proportion of all cases that can be attributed to a particular exposure. It is the risk difference divided by the incidence in the exposed population. When a specific exposure is believed to be a cause of a given disease, the attributable fraction is the proportion of the disease in the specific population that would be eliminated if the exposure were eliminated.
Relative comparison measures include the following:
o Relative risk (risk ratio) is the ratio of the risk of occurrence of a condition among exposed people to that among the unexposed. The risk ratio is a better indicator of the strength of an association than the risk difference because it is expressed relative to a baseline level of occurrence.
o Attributable risk is the proportion of a disease or other outcome in exposed individuals that can be attributed to the exposure. This is a valuable measure for public health. It reflects the amount, usually expressed as a percentage, by which the risk of a disease is reduced by eliminating or controlling a particular exposure.

Question 20

Four types of factors play a part in disease causation

Answer 20

1. Predisposing factors (e.g., age or specific genetic trait).
2. Enabling factors (e.g., low socio-economic status, limited access to medical care) may favour disease development. Conversely, circumstances that assist in recovery from illness or in the maintenance of good health could also be called enabling factors.
3. Precipitating factors such as exposure to a specific disease agent may be associated with the onset of a disease.
4. Reinforcing factors such as repeated exposure or environmental conditions may aggravate an established condition.

Question 21

Considerations when establishing causation (8)

Answer 21

• Temporal relationship - does the cause precede the effect?
• Plausibility – is the association consistent with other knowledge?
• Consistency – have similar results been shown in other studies?
• Strength – what is the power of the association between the cause and the effect? (e.g., in terms of relative risk). Note that weakness of association does not preclude causality.
• Dose-response relationship – is increased exposure to the possible cause associated with increased effect?
• Reversibility – does the removal of a possible cause lead to a reduction of disease risk?
• Study design – is the evidence based on a solid study design?
• Judging the evidence – how many evidentiary pathways lead to the conclusion?

Question 22

Four levels of prevention, corresponding to different phases in the development of disease, are

Answer 22

• The primordial level targets underlying economic, social, and environmental conditions leading to causation, i.e., reducing lung disease incidence through the introduction of tobacco control legislation.
• Primary prevention limits disease incidence by controlling specific causes and risk factors. A good example is requiring car occupants to wear seat belts to prevent the risk of road traffic-related harm at the population level. Another example is encouraging people in higher-risk groups (such as the elderly or those with chronic illnesses) to have the influenza vaccination at the specific group level.
A Practitioner’s Guide to Health Informatics in Australia
Part One – Health sciences
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• Secondary prevention aims to reduce the more severe consequences of disease through early diagnosis and treatment, such as breast cancer screening.
• Tertiary prevention aims to reduce the progress of complications/impairments from established disease. Tertiary prevention may be difficult to separate from treatment. An example is rehabilitation patients with acquired brain injuries, aiming to prevent further functional decline.

Question 23

Exlpain sensitivity vs specificity

Answer 23

Sensitivity = probability of a positive test in people with the disease = a divided by (a+c).
Specificity = probability of a negative test in people without the disease = d divided by (b+d).
Positive predictive value = probability of the person having the disease when the test is positive = a divided by (a+b).
Negative predictive value = probability of the person not having the disease when the test is negative = d divided by (c+d)

Question 24

How do we assess the merits of diagnostic tests

Answer 24

Predictive value depends on the sensitivity and specificity of the test and the prevalence of the disease in the population of interest.
“Even with a high sensitivity and high specificity, if the prevalence is low the positive predictive value of a test may be very low. The predictive values of a test in clinical practice depend critically on the prevalence of the abnormality in the patients being tested; this may well differ from the prevalence in a published study on the usefulness of the test.”

Question 25

Expossure and dose in environmental and occupational epidemiology

Answer 25

the concepts of exposure and dose are particularly important in environmental and occupational epidemiology. Exposure has two dimensions: level and duration. Some contaminants (e.g., chemical spills) cause immediate effects, and current exposure is crucial. For others, such as radiation and lead, the effects are cumulative, and history of exposure is more important.

Question 26

Difference between dose effect and dose response

Answer 26

• Dose-effect concerns the relationship between dose and severity of effect in an individual.
• Dose-response describes how the likelihood and severity of adverse health effects (the responses) are related to the amount and condition of exposure to an agent (the dose provided).
Dose effect relationships can establish the nature of the impact of dose on effect but fall short of describing the frequency with which a population is affected to any specific degree. Dose-response relationships describe the latter. Accordingly, these relationships can assist in determining which effects are most important to prevent, acceptable response levels and the maximum acceptable exposure levels.

Question 27

Major issues in applying epidemiology to public policy include

Answer 27

• Making judgements about the cause of disease and decisions on what to do when the evidence is incomplete.
• The relative ease of discovering contrary points of view and polarising (sub-) populations, such as fluoridation and childhood immunisations, particularly when substantive commercial interests are involved (e.g., tobacco and alcohol usage).
• Balancing health and other interests such as economic growth.

Question 28

Define burden of disease

Answer 28

Burden of disease is a measure used to assess and compare the relative impact of different diseases and injuries on populations. It quantifies the health loss, due to disease and injury, that remains after treatment, rehabilitation, or prevention efforts.

Question 29

Why is data linkage good

Answer 29

Data linkage (also called data integration or record matching) can generate more complete pictures of the health of communities than is possible using other research methods. It is a very cost-effective research tool once the linkage infrastructure is in place.

Question 30

Issues associated with data linkage include:

Answer 30

• Ensuring that data matching is accurate – i.e., the records linked pertain to the same patient.
• Data linkage is highly sensitive to the quality of the data being linked, including consistency of the associated metadata, data completion and complementary coverage. What happens if conflicting data are discovered in matching records?
• Regulatory barriers to the linking of data sets.
• Privacy and confidentiality. Are the subjects of care aware that their data is being linked? Do they need to be? Have they consented? Do they need to?6 Can inadvertent breaches of confidentiality be controlled?

Question 31

5 groups of OED health systems

Answer 31

National Health Insurance (private and public, tax finacing)
National Health Service (all public)
Social Health Insurance (private with societal actors in control)
Ewtatist Social Health Insurance (private with state regulation but societal financing)
Private insurance (no state)

Question 32

defines virtual health

Answer 32

“A healthcare delivery approach that is driving continuous, connected, coordinated care across the continuum via digital and telecommunication technologies”.
• Telehealth – virtual consultations/interventions, triage and advice, and remote patient monitoring.
• Virtual health education, training and promotion.
• Virtual care planning and coordination
• Health-smart environments.
• Self-care, including wellness management, undertaken virtually.

Question 33

3 teleheath categories are

Answer 33

Synchronous communications are interactive and occur in real-time. Real-time telehealth (virtual consultations, triage and advice) may be conducted via telephone or videoconferencing. Telephone predominates in Australia, however, accounting for well over 90% of MBS-subsidised telehealth services (Snoswell et al., 2021).
Virtual consultations are typically geared towards non-urgent care services, treating common ailments that don’t require the patient to attend face-to-face – e.g., that do not require a physical examination involving touch. Because they avoid the time and cost of waiting and travel, they have traditionally been associated with geographic separation between provider and consumer. Covid-19, however, demonstrated there is more than one reason for separation.

Asynchronous communications are not in real-time. Instead, they support the secure electronic transmission of information such as medical records, test results, images and text between health professionals who can then deal with them off-line. This is an advantageous mode by which clinicians in rural and remote areas can access specialists who may be not available for real-time consultation or dialogue.

Remote patient monitoring refers to digital technologies to measure vital signs and other clinical data (e.g., weight, blood pressure, blood sugar, blood oxygen levels, heart rate, and EKGs), monitored remotely by health professionals – sometimes using AI as an intermediary. Typical remote monitoring applications include enabling older, chronically ill, and/or disabled people to live at home with professional support.

Question 34

The National Health Reform Agreement sets out the shared intention of the Commonwealth, State and Territory governments to work in partnership to improve health outcomes for all Australians and ensure the sustainability of the Australian health system. It details four strategic priorities for the period 2020 – 2025:

Answer 34

1. Improving efficiency and ensuring financial sustainability (Schedule A);
2. Delivering safe, high-quality care in the right place at the right time, including long-term reforms in:
   i. Nationally cohesive health technology assessment;
   ii. Paying for value and outcomes; and
   iii. Joint planning and funding at a local level.
3. Prioritising prevention and helping people manage their health across their lifetime, including long-term reforms in:
   i. Empowering people through health literacy; and
   ii. Prevention and wellbeing; and
4. Driving best practice and performance using data and research, including long-term reforms in:
   i. Enhanced health data.

Question 35

The definition of clinical governance used in the National Safety and Quality Health Service Standards is

Answer 35

“the set of relationships and responsibilities established by a health service organisation between its state or territory department of health (for the public sector), governing body, executive, clinicians, patients, consumers and other stakeholders to ensure good clinical outcomes.9 It ensures that the community and health service organisations can be confident that systems are in place to deliver safe and high-quality health care, and continuously improve services.”

Question 36

Define the difference between Health informatics — Functional and Structural Roles

Answer 36

Roles can be structural (e.g., licensed general practitioner, non-licensed transcriptionist) or functional (e.g., a provider member of a therapeutic team or an attending physician). Structural roles are relatively static, often lasting for many years. They deal with relationships between entities expressed at a level of complex concepts. Functional roles are bound to the realisation of actions and are highly dynamic. They are typically represented as decomposed, fine-grained concepts