Domain 2: Improving Care Delivery & Outcomes Flashcards
Other terms for sensitivity
True positive rate
Recall
Other term for specificity
True negative rate
Other term for positive predictive value
Precision
What does square, circle and triangle represent in decision tress?
Square = decision node
Circle = change node
Triangle = outcome node
What are 3 tools for quantifying patient utility?
Standard gamble
Time trade-off
Visual analogue
Formula for positive likelihood ratio (LR+)
Sensitivity / 1-Specificity = TPR / FPR (how much a positive test makes the diagnosis more likely)
Formula for negative likelihood ratio (LR-)
1-Sensitivity / Specificity = FNR / TNR (how much a negative test makes the diagnosis less likely)
Formula to convert probability to odds
Odds = prob / 1-prob
Formula to convert odds to probability
Prob = odds / 1+odds
What’s a rollback calculations in decision-tree analysis?
Multiplying each outcome (e.g. QALY) by it’s probability and then adding all the probabilities about a chance node
Process for calculating posterior probability given X% prior probability
- Convert X% probability to odds
- Multiple by LR+
- Calculate posterior odds
What causes semantic ambiguity
Insufficient detail
EX) specimen should be sent to lab for further handling. Which lab?
What causes syntactic ambiguity
Language that prevents translation into a machine-interpretable condition or syntax.
Ex) A or B and C. Missing parentheses?
What causes conditional ambiguity
Component of a condition is insufficiently detailed
Ex) If US is suggestive of appendicitis THEN perform CT abdomen. It is not clear what features of US would count as “suggestive of appendicitis.”
5 rights of CDS
Right information
Right person
Right format
Right channel
Right time
What tool is used to represent the next planned change for an organization
Logic model (aka theory of change, road map)
6 ways to deal with resistance in the Kotter & Schlesinger’s change management strategy
- Education & Communication
- Participation and involvement
- Facilitation and support
- Negotiation and agreement
- Manipulation & Co-optation
- Explicit and implicit coercion
4 social computing phenomena which exert influence on adoption of technology
Action, authority, consensus and cooperation
intra-group social and business actions practiced through group consensus, group cooperation, and group authority, where such actions are made possible through the mediation of information technologies, and where group interaction causes members to conform and influences others to join the group.
Kubler-Ross Grief Cycle
DABDA
Denial
Anger
Bargaining
Depression
Acceptance
According to Roger’s Diffusion of Innovation theory, rate of adoption of an innovation is determined by:
- Relative advantage
- Compatibility
- Complexity
- Trialability
- Observability
What is value bias?
Tendency to interpret data in a way that supports a decision that is very valuable or highly desired
How do you calculate Hazard Ratio
(Risk in study group) / (Risk in control group)
What are Lewin’s 3 steps of change
Unfreezing, Moving, Refreezing
What does oval, square and diamond shape represent in a process map?
Oval = beginning & end
Square = middle steps
Diamonds = points where a decision needs to be made
5 adopter categories according to Diffusion of Innovation (DOI)
- Innovators
- Early Adopters - do not need info to convince them to change
- Early Majority - need to see evidence the innovation works
- Late Majority - skeptical of change and will only adopt after it has been tried by the majority
- Laggards
Difference between leading vs lagging indicators
Leading indicators look FORWARD to predicting future success and tend to be INPUT oriented (e.g. number of open ambulatory encounters)
Lagging indicators LOOK BACK to evaluate past success and therefore more OUTPUT oriented (e.g. revenue collected)
What is a technology-induced error?
Error that result from the complex interaction of health information systems and end users, when systems are used in complex healthcare settings.
How to calculate time trade-off
Years in perfect health / Years with illness
Ex) Patient says 4 years of perfect health = 10 years of current illness –> Time trade off = 0.4
Equation for expected value
(winning amount x chance of winning) + (losing amount x chance of losing)
Which change theory is concerned with compliance, identification, internalization, conformity, obedience, and persuasion
Social Influence Theory
When is complex adaptive systems change theory most helpful?
- Most help during planning phase of change and early implementation phase
What change theory is concerned with analyzing relationship between components of a system and often tries to apply mathematics?
Complex adaptive systems
AKA Complex Theory or Systems Theory
5 attributes of system usability
- Learnability: system should be relatively easy to learn
- Efficiency: an experienced user can attain a high level of productivity
- Memorability: features supported by the system should be easy to retain once learned
- Errors: system should be designed to minimize errors and support error detection and
- Satisfaction: the user experience should be subjectively satisfying
What is Grounded Theory?
- Ethnographic workflow analysis method
- Uses inductive analysis (analysis occurs in parallel with data collection)
- Data broken down into codes –> codes combined to categories
- Helpful in uncovering hidden triggers or cultural taboos
What is PRECEDE-PROCEED?
Example of change theory
PRECEDE = diagnostic phase (assessment of organization’s readiness for change)
PROCEED = evaluation phase
What is Bridges’ Transition Theory
Psychological transitions of people are more difficult than tech change itself (80% people / 20% tech)
3 phases of change
1. Loss
2. Neutral Zone
3. New Beginning
3 phases of Change Management Strategies for Systems
- Creating a climate for change
- Engaging & Enabling the Organization
- Implementing and Sustaining the Changes
6 barriers to effective implementation of new EHR system per Qualis Health experience in primary care settings
- Leadership
- Workflow
- Provider
- Training
- Data Interface
- User Interface
QI tool established by Frederick Taylor in 1890s
Scientific Management
QI tool established by Walter Shewhart, Western Electric Co.
Statistical Process Control
QI tool established by W. Edwards Deming
Theory of Improvement
PDSA cycle
3 types of measures according to Donabedian Quality Framework
- Structure
- Process
- Outcome
What is FMEA
Failure Mode & Effects Analysis
- Used to select target for change/improvement
- Modes of failure in process can be risk-prioritized according to severity (S) of the failure, frequency of occurrence (O) and detectability (D)
Risk Priority Number (RPN) = S x O x D
How do you define Upper/Lower Control Limit & Upper/Lower Warning Limit
UCL = +3 sigma
LCL = -3 sigma
UWL = +2 sigma
LWL = -2 sigma
99.73% fall within +/- 3 sigma
What does “Shift” refer to in Special Cause Terminology?
A run of 6 or more points on the same side of center line
What does “Trend” refer to in Special Cause Terminology?
5 consecutive points going in same direction
What does “Run” refer to in Special Cause Terminology?
Too few or too many events crossing the center line
Steps of Six Sigma
DMAIC
- Define
- Measure
- Analyze
- Improve
- Control
7 types of Muda
- Overproduction
- Inventory
- Defects (Repairs)
- Motion
- Overprocessing
- Waiting
- Transport
Types of SPC chart for counts
C chart - equal area of opportunity (constant sample size)
Ex) Number of workplace injuries per month
U chart - Unequal area of opportunity (variable sample size)
Ex) Number of line infections per 1000 patient days
P chart - proportion
Ex) Proportion of patients who had med rec performed per encounter
Types of SPC charges for continuous variables (e.g. time, money, things measured on a scale like height or weight)
I chart (aka X chart) - single measure
Ex) Variation in patient days per month & Time from ED to OR for sequential cases of isolated femur fracture
X-bar and S Chart - average of multiple measures
Ex) Average TAT for STAT CBC tests per month
Equation for healthcare value
Value = Quality / Cost
What quality measure is published by NCQA (National Committee for Quality Assurance)?
Health Effectiveness Data and Information Set (HEDIS) performance measures
What is the role of ONC?
- Established certification criteria for EHR
- Established HIE standards
What quality standard has been established by Joint Commission?
National Patient Safety Goals (NPSG)
Ex) Reduction of MDRO, catheter-related bloodstream infection
What does the Council on Quality and Leadership do?
Accredits organizations that care for patients with intellectual, psychiatric and developmental disabilities
What is HQMF (Healthcare Quality Measure Format)?
Standards-based representation of quality measure as an XML document
What is CQL (Clinical Quality Language)?
- Expression logic used in HQMF
- An HL7 Standard for Trial Use (STU), which is now the standard for logic representation in eCQM
- Replaced logic expression in QDM (Quality Data Model)
What is QRDA (Quality Reporting Document Architecture)?
Quality Reporting Document Architecture for eCQIs based on HL7 CDA
How are physicians payed through MACRA (Medicare Access and CHIP Reauthorization Act)?
MIPS = Merit Based Incentive Payment System
OR
APM = Alternative Payment Models
How does MACRA rate physicians?
Based on NCQA quality maesures, including HEDIS scores, PCMH, PCSP (Patient Centered Specialty Practice), and MU
What 3 things were consolidated into MIPS?
PQRS (Physician Quality Reporting System)
VBPM (Value-Based Payment Modifier)
MU (Meaningful Use)
In telehealth what does originating site refer to?
Location of the patient at the time the service is being provided
