Exam 1 Flashcards
How fast has medical knowledge expanding over the years?
1950-50years
1980-7years
2010-3.5years
2020-73days
What makes a good team?
Honesty, humility, discipline, creativity, curiosity
What is unity of purpose?
team works to establish shared goals
What is knowledge of limitations?
clear delineation of each person’s skill set and abilities
What is maximizing contribution of individual skills?
Clear expectation for each member’s functions, responsibilities, and accountabilities
What is resource efficiency?
Choosing methods of providing care to allow the maximal quality of care with minimal wasting of resources.
What is fee-for-service healthcare?
services to a patient are unbundled and paid for separately
What is value-based care?
payment or incentive for achieving defined and measurable goals related to patient care
umbrella term-covers several subtypes
PREFERED BY MEDICARE/MEDICAID
What is episode/bundled payments(VBC)?
-singular payments for a group of services related to a particular treatment or condition
-different providers split the total bundled payment
-based on average cost of care for a given situation
What is capitation/comprehensive care(VBC)?
-single risk-adjusted payment for full range of healthcare services needed by a specific group for a fixed period
-covers the cost for multiple patients
-some versions only cover outpatient fees, others cover inpatient care as well
What is accountable care organization(VBC)?
-providers of varying specialities enroll as a group to provider comprehensive care
-promotes increased communications and less overlap
-receive risk-based payments that are divided among providers/clinics
What is health maintenance organization(HMO)?
single entity that encompasses patient’s insurance and medical providers
How does HMOs work?
-network of providers and entities that offer care to a patient
-patient pays HMO for their portion of their cost of care
-financial incentives to stay within their HMO
What is preferred provider organization(PPO)?
network of third-party providers contracted with a patient’s insurance or health coverage
How does PPOs work?
-providers accept regulation from the insurance
-patients receive financial incentives to stay “in-network”
What is point of service(POS)?
patient only has to pay a copay or coinsurance when in-network
How does POS work?
-combines HMO and PPO principles
-patients can get low-cost baseline of care through an HMO
-patients have flexibility to choose providers out of HMO that still in a PPO network
-can go completely out-of-network
-tends to cost more than HMO and PPO alone
What are the features of the patient centered medical home(PCMH)?
-patient centered
-comprehensive
-coordinated
-accessible
-committed to quality and safety
Why are PCMH good?
-up to 70% reductions in ER visits
-40% lower hospital readmissions
-hundred of millions of health care dollars saved
What is the difference between PCMH and accountable care organization(ACO)?
-ACOs function as payment model shared by multiple providers in multiple practices
-PCMH functions as a model for holistic patient care performed by a single practice/entity
What is the main difference between allopathic and osteopathic physicians?
Allopathic: “treaters”
Osteopathic: “preventers”; holistic, “whole patient”
Why is it impossible to keep up with new information?
-textbook information can be outdated by the time its published
-reading several journals only offers a sample of new developments
-difficult to find a specific topic in journals
-colleagues and consultants may not be available or have biases
What are three wrong ways to approach a medical practice?
Expert opinion, anecdotal evidence, and defensive-based medicine
How do we constantly evaluate your own performance?
Self-awareness, self-direction, and active learning
What are some flaws of EBM?
-always getting updated
-too much evidence
-statically significant may/maynot be clinically significant
-poorly suited to comorbidities
-what about patient preference?
What are the fundamentals of evidence based practice?
best research evidence
knowledge and skill
collaborative, patient-centered decisions
context of a given clinical situation
What is level 1 of evidence?
at least one properly conducted randomized controlled trial, systematic review, or meta-analysis
What is level 2 of evidence
other comparison trials, non-randomized, cohort, case-control, epidemiological
What is level 3 of evidence?
Expert opinion, consensus statements, animal studies
What are practice guidelines and what was the one called for blood pressure?
systematically developed statements to assist practitioner and patients decisions about appropriate healthcare or specific clinical circumstances
Joint National Committee VIII Hypertension guidelines
What are the two parts of a practice guideline?
- foundation is a systemic review of search evidence bearing on a clinical question, focusing on the strength of the evidence
- involves both evidence and value judgements, is a set of recommendations for how patients with that condition should be managed, everything else being equal
What should we check to recognize credible guidelines?
Expertise, evidence based, comprehensive, recency, sponsoring society, and outside review and endorsement
What is another guideline for hypertension that difference from the JNC?
American college of cardiologists
How do practice guidelines adapt?
individual patient characteristics, preferences of practitioners and patients, local circumstances
What should useful information sources for clinicians include?
Rapid access(within minutes), targeted to specific clinical questions, best and most current research information, simple to use
What are some sources for evidence-based information?
UpToDate, US preventative services task force, ACP journals club online, Cochrane database, guideline.gov
what does epi-demos-ology mean?
upon+population+study
what does investigating a disease or disorder include?
-factors that determine and presence or absence of a given disease
-how disease traits and prevalence change over time
-how the disease affects society/economy
What can epidemiology be used for?
-help plan and evaluate strategies to prevent illness
-guide the management of patients with that disease
What are some common professional backgrounds that epidemiologists have?
MD/DO
MPH
DrPH
PhD population/public health
MS in epidemiology
What are typical places of employment for epidemiologist?
universities
centers for disease control and prevention
health protection agency
WHO
state/regional government public health agencies
What do epidemiologists do?
investigate and study diseases, community health surveillance, setting dies control priorities, establishing health care policy, and improving diagnosis, treatment, and prognosis
What are the typical research designs and what do they show?
Descriptive studies: information collected without manipulation
Analytic studies: done to find out if an outcome is related to exposure
Experimental studies: interventions done and results observed
What are the 4 major factors of diseases?
Host(affected)
Agent(causing)
Environment(Conditions)
Vector(transmission)
BEINGS Model
Biological/Behavior factors
environmental factors
immunological factors
nutriton factors
genetic factors
services, social factors, spiritual factors
What are some examples of biological and behavior factors?
gender, age, weight, bone density, smoking, general activity level, sexual activity, drug use
What are some environmental factors?
ventilation systems, dust mites ticks, sun exposure, sanitation, socioeconomic status
What are some examples of immunological factors?
Herd immunity
Immunosuppression
Vaccination status
What are some examples of nutritional factors?
Western diet, dietary deficiencies, fiber intake
What are some examples of genetic factors?
heritability, gene mutation, gene duplication or omission
What are examples of services/social/spiritual factors?
medical care services and medical errors
social
spiritual support
What is the definition of ecology?
branch of biology dealing with relations and interactions between organism and their environment, including other organisms
What was an unintended consequence of vaccinations for childhood infection?
decrease in level of immunity during adulthood to lack of repeated exposures to infection
What was an unintended consequence of improved sanitation to high infant mortality rate?
increase population growth rate; epidemic paralytic poliomyelitis; epidemic Hep A
What was an unintended consequence of control of tsetse fly for sleeping sickness in cattle?
increase in area of land subject to overgrazing and drought due to increased cattle population
What was an unintended consequence of erection of large river dams for malnutrition and the need for a larger area of tillable land?
increase in rates of some infectious diseases due to water system changes that favor disease vectors
What are the big investigation of diseases and agent/route of spread?
Lyme: disease ticks
Toxic shock syndrome: staphylococcal toxin, tampons
AIDS:viral, sexual activity, blood/blood products
SARS: animal coronavirus from handling and eating unusual animal foods
Covid-19: viral agent, via airborne and droplet
How does epidemiology improve disease outcomes?
improves diagnosis, treatment, and prognosis
What is the numerator in rates of epidemiology?
Events/conditions of concern
What is the denominator in rates of rates of epidemiology?
population at risk
What place is diabetes in the leading cause of death?
7th
What are patients with diabetes more susceptibility to?
2-5x more likely to get cardiovascular disease
What are the US health databases?
US vital statistics systems
National notifiable disease surveillance system
National Center for health statistics(NCHS)
Behavior risk factor surveillance system
Disease registries:(Connecticut tumor registry)
Data from third-party payers
Novel registries:(national weight control registry)
What are the fundamental measurements in epidemiology?
frequency:
incidence(how many get the disease during time period)
prevalence(has the disease at a point in time)
point prevalence(has the disease at a point in time)
period prevalence(specific time interval)
What is a case fatality ratio?
proportion of clinically ill persons who die
What is a mid period population?
A good estimate for the average number of people at risk for the outcome during the time period
Often used as the denominator
What is the difference between crude, specific, and standardized(adjusted) rates?
Crude rates: rates for entire population
Specific rates: division into subgroups(age, sex, race, risk factors, or comorbidity)
Standardized rates: crude rates modified to control for the effects of other variables
What are the different subcategories and rates of hypertension?
Primary(“essential”) HTN: 95% of cases
Secondary HTN: 5% of cases
What is a cause of 2ndary HTN?
adrenal gland tumor that secretes adrenaline called pheochromocytoma(accounts for less than .1% of HTN cases)
What is the difference between incidence rate and prevalence rate?
Incidence is a number of cases/population at risk at midpoint of the defined study point
Prevalence rate is a percentage
