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PCC Exam 1 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

How fast has medical knowledge expanding over the years?

A

1950-50years
1980-7years
2010-3.5years
2020-73days

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2
Q

What makes a good team?

A

Honesty, humility, discipline, creativity, curiosity

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3
Q

What is unity of purpose?

A

team works to establish shared goals

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4
Q

What is knowledge of limitations?

A

clear delineation of each person’s skill set and abilities

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5
Q

What is maximizing contribution of individual skills?

A

Clear expectation for each member’s functions, responsibilities, and accountabilities

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6
Q

What is resource efficiency?

A

Choosing methods of providing care to allow the maximal quality of care with minimal wasting of resources.

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7
Q

What is fee-for-service healthcare?

A

services to a patient are unbundled and paid for separately

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8
Q

What is value-based care?

A

payment or incentive for achieving defined and measurable goals related to patient care

umbrella term-covers several subtypes

PREFERED BY MEDICARE/MEDICAID

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9
Q

What is episode/bundled payments(VBC)?

A

-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

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10
Q

What is capitation/comprehensive care(VBC)?

A

-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

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11
Q

What is accountable care organization(VBC)?

A

-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

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12
Q

What is health maintenance organization(HMO)?

A

single entity that encompasses patient’s insurance and medical providers

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13
Q

How does HMOs work?

A

-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

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14
Q

What is preferred provider organization(PPO)?

A

network of third-party providers contracted with a patient’s insurance or health coverage

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15
Q

How does PPOs work?

A

-providers accept regulation from the insurance
-patients receive financial incentives to stay “in-network”

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16
Q

What is point of service(POS)?

A

patient only has to pay a copay or coinsurance when in-network

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17
Q

How does POS work?

A

-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

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18
Q

What are the features of the patient centered medical home(PCMH)?

A

-patient centered
-comprehensive
-coordinated
-accessible
-committed to quality and safety

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19
Q

Why are PCMH good?

A

-up to 70% reductions in ER visits
-40% lower hospital readmissions
-hundred of millions of health care dollars saved

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20
Q

What is the difference between PCMH and accountable care organization(ACO)?

A

-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

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21
Q

What is the main difference between allopathic and osteopathic physicians?

A

Allopathic: “treaters”
Osteopathic: “preventers”; holistic, “whole patient”

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22
Q

Why is it impossible to keep up with new information?

A

-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

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23
Q

What are three wrong ways to approach a medical practice?

A

Expert opinion, anecdotal evidence, and defensive-based medicine

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24
Q

How do we constantly evaluate your own performance?

A

Self-awareness, self-direction, and active learning

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25
Q

What are some flaws of EBM?

A

-always getting updated
-too much evidence
-statically significant may/maynot be clinically significant
-poorly suited to comorbidities
-what about patient preference?

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26
Q

What are the fundamentals of evidence based practice?

A

best research evidence
knowledge and skill
collaborative, patient-centered decisions
context of a given clinical situation

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27
Q

What is level 1 of evidence?

A

at least one properly conducted randomized controlled trial, systematic review, or meta-analysis

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28
Q

What is level 2 of evidence

A

other comparison trials, non-randomized, cohort, case-control, epidemiological

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29
Q

What is level 3 of evidence?

A

Expert opinion, consensus statements, animal studies

30
Q

What are practice guidelines and what was the one called for blood pressure?

A

systematically developed statements to assist practitioner and patients decisions about appropriate healthcare or specific clinical circumstances

Joint National Committee VIII Hypertension guidelines

31
Q

What are the two parts of a practice guideline?

A
  1. foundation is a systemic review of search evidence bearing on a clinical question, focusing on the strength of the evidence
  2. involves both evidence and value judgements, is a set of recommendations for how patients with that condition should be managed, everything else being equal
32
Q

What should we check to recognize credible guidelines?

A

Expertise, evidence based, comprehensive, recency, sponsoring society, and outside review and endorsement

33
Q

What is another guideline for hypertension that difference from the JNC?

A

American college of cardiologists

34
Q

How do practice guidelines adapt?

A

individual patient characteristics, preferences of practitioners and patients, local circumstances

35
Q

What should useful information sources for clinicians include?

A

Rapid access(within minutes), targeted to specific clinical questions, best and most current research information, simple to use

36
Q

What are some sources for evidence-based information?

A

UpToDate, US preventative services task force, ACP journals club online, Cochrane database, guideline.gov

37
Q

what does epi-demos-ology mean?

A

upon+population+study

38
Q

what does investigating a disease or disorder include?

A

-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

39
Q

What can epidemiology be used for?

A

-help plan and evaluate strategies to prevent illness
-guide the management of patients with that disease

40
Q

What are some common professional backgrounds that epidemiologists have?

A

MD/DO
MPH
DrPH
PhD population/public health
MS in epidemiology

41
Q

What are typical places of employment for epidemiologist?

A

universities
centers for disease control and prevention
health protection agency
WHO
state/regional government public health agencies

42
Q

What do epidemiologists do?

A

investigate and study diseases, community health surveillance, setting dies control priorities, establishing health care policy, and improving diagnosis, treatment, and prognosis

43
Q

What are the typical research designs and what do they show?

A

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

44
Q

What are the 4 major factors of diseases?

A

Host(affected)
Agent(causing)
Environment(Conditions)
Vector(transmission)

45
Q

BEINGS Model

A

Biological/Behavior factors
environmental factors
immunological factors
nutriton factors
genetic factors
services, social factors, spiritual factors

46
Q

What are some examples of biological and behavior factors?

A

gender, age, weight, bone density, smoking, general activity level, sexual activity, drug use

47
Q

What are some environmental factors?

A

ventilation systems, dust mites ticks, sun exposure, sanitation, socioeconomic status

48
Q

What are some examples of immunological factors?

A

Herd immunity
Immunosuppression
Vaccination status

49
Q

What are some examples of nutritional factors?

A

Western diet, dietary deficiencies, fiber intake

50
Q

What are some examples of genetic factors?

A

heritability, gene mutation, gene duplication or omission

51
Q

What are examples of services/social/spiritual factors?

A

medical care services and medical errors
social
spiritual support

52
Q

What is the definition of ecology?

A

branch of biology dealing with relations and interactions between organism and their environment, including other organisms

53
Q

What was an unintended consequence of vaccinations for childhood infection?

A

decrease in level of immunity during adulthood to lack of repeated exposures to infection

54
Q

What was an unintended consequence of improved sanitation to high infant mortality rate?

A

increase population growth rate; epidemic paralytic poliomyelitis; epidemic Hep A

55
Q

What was an unintended consequence of control of tsetse fly for sleeping sickness in cattle?

A

increase in area of land subject to overgrazing and drought due to increased cattle population

56
Q

What was an unintended consequence of erection of large river dams for malnutrition and the need for a larger area of tillable land?

A

increase in rates of some infectious diseases due to water system changes that favor disease vectors

57
Q

What are the big investigation of diseases and agent/route of spread?

A

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

58
Q

How does epidemiology improve disease outcomes?

A

improves diagnosis, treatment, and prognosis

59
Q

What is the numerator in rates of epidemiology?

A

Events/conditions of concern

60
Q

What is the denominator in rates of rates of epidemiology?

A

population at risk

61
Q

What place is diabetes in the leading cause of death?

A

7th

62
Q

What are patients with diabetes more susceptibility to?

A

2-5x more likely to get cardiovascular disease

63
Q

What are the US health databases?

A

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)

64
Q

What are the fundamental measurements in epidemiology?

A

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)

65
Q

What is a case fatality ratio?

A

proportion of clinically ill persons who die

66
Q

What is a mid period population?

A

A good estimate for the average number of people at risk for the outcome during the time period
Often used as the denominator

67
Q

What is the difference between crude, specific, and standardized(adjusted) rates?

A

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

68
Q

What are the different subcategories and rates of hypertension?

A

Primary(“essential”) HTN: 95% of cases
Secondary HTN: 5% of cases

69
Q

What is a cause of 2ndary HTN?

A

adrenal gland tumor that secretes adrenaline called pheochromocytoma(accounts for less than .1% of HTN cases)

70
Q

What is the difference between incidence rate and prevalence rate?

A

Incidence is a number of cases/population at risk at midpoint of the defined study point
Prevalence rate is a percentage

PCC Exam 1 (1 decks)

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