Exam 1 Flashcards
What makes a good team?
Honesty
Discipline
Creativity
Humility
Curiousity
What are the four fundamental teamwork concepts?
Unity of Purpose
Knowledge of Limitations
Maximizing Contribution of Individual Skills
Resource Efficiency
Define Fee For Service vs Value-Based Care
Fee for service:
Paid per service
Price inflation
Value-Based Care:
Payment based on quality
Can bring down price of care
FAVORED BY MEDICARE/MEDICAID
What are some pros and cons for FFS?
Pros: Simplicity, Productivity, Flexibility
Cons: Quantity over Quality, Inflationary, thwarts “free” activities, not always efficient.
What are some pros and cons for VBC?
Pros: Quality, efficiency, improve collaboration, emphasis on outcomes, FAVORED BY MEDICARE/MEDICAID
Cons: How to measure? What to measure?
“Firing bad patients”
Focused only on certain outcomes
More admin work
Do payer goals = patient goals???
What are the pros and cons of Episode/Bundled reimbursement model?
Pros: Efficiency, improve collaboration, simple billing
Cons: What defines an episode? What if everyone isn’t on board, Avoiding “bad”/complex patients
Explain a Episode/Bundled reimbursement model.
Single payments for a group of services related to a treatment or condition.
Different providers must split the cost.
Cost is determined based on averages.
It is a type of VBC.
Explain a Capitation/Comprehensive Care reimbursement model.
Single risk-adjusted payment for a full range of healthcare services needed by a group for a time period.
Covers cost of MULTIPLE patients.
Some cover outpatient, inpatient, or both.
Note: Health is promoted since outpatient providers want to get paid.
It is a type of VBC.
What are the pros and cons of a Captitation/Comprehensive Care reimbursement model?
Pros: Flexibility, Innovation, Efficiency, Improve collaboration, Maximizing health of patient!
Cons: How much risk? Is my doctor withholding care? How to get everyone on board? Avoid bad/complex patients, quantity over quality?
Explain an Accountable Care Organization reimbursement model.
Providers of varying specialties enroll as a GROUP to provide comprehensive services.
Promotes increased communication and less overlap.
Receive risk-based payments that are divided.
It is a type of VBC.
What are the pros and cons of an accountable care organization reimbursement model?
Pros: Efficiency, Improve collaboration, maximizing health, CONTINUITY of care
Cons: What if the specialty I need is not in the group?
Is my doctor withholding care?
Avoiding bad/complex patients.
Monopolies of care, moreso in RURAL areas.
What are the three types of VBCs?
Episodic/Bundled, Capitation/Comprehensive Care, and Accountable Care Organization
What is included in a managed care organization?
HMOs, PPOs, and POS
Compare and contrast an HMO and PPO.
HMO, or health maintenance organization, is a single entity providing patient’s insurance and providers. Patient pays HMO for their portion of the cost. They stay within their HMO network and are financially incentivized to do so. (Cheaper)
PPO, or Preferred Provider Organization, is a network of third-party providers contracted either with a patient’s insurance or heath coverage. Providers are regulated by the insurance and you are also encouraged to stay in network.
What is a POS managed care model?
Point of Service, where the pt only pays a copay/coinsurance when in-network.
It is a combination of an HMO and PPO.
Patients can get their baseline care from the HMO, but get specialty care outside of the HMO network but in the PPO network. they can also go out of network.
TENDS TO COST MORE THAN EITHER ALONE.
What makes up a PCMH?
Patient-centered medical home
Including services for:
Medical
Educational
Spiritual/Religious
Patient Support
Financial
Mental Health
What is the main difference between an ACO and a PCMH?
ACOs are payment models with multiple providers in multiple practices.
PCMH are run by a single practice/entity usually.
What are some benefits of a PCMH?
70% reduction in ER visits
40% lower readmits
Lots of money saved
What is the main difference between an MD and DO in care philosophy?
MD: Treaters
DO: Preventers, Holistic, whole patient
What are most dentists specialized in?
80% Generalized
20% Specialized
Difference between a podiatrist and an MD/DO?
Podiatry school is SEPARATE from MD/DO school. Both doctorate level.
What are the 4 types of APRNs?
NPs, Nurse Midwife, CRNA, and clinical nurse specialist
What are the clinical nursing titles?
RN, via an ASN, BSN or MSN
LPN
CNA
Define Evidence Based Medicine
The care of patients using the best available research evidence to guide and optimize clinical decision making.
What are the 4 approaches to practice?
EBM
Expert opinion
Anecdotal evidence
Defensive-based Medicine
What is the main pro of EBM?
Constantly evaluating your own performance via self-awareness, self-learning, and active learning.
What are some flaws of EBM?
Evidence can change (Ex: Phocomelia & Thalidomide)
Is a statistically significant finding clinically significant?
Patient’s preference
What are the 3 levels of evidence?
Level 1: At least 1 properly randomized controlled trial, systematic review, or meta-analysis.
Level 2: Other comparison trials, non-randomized, cohort, case-control, epidemiologic
Level 3: Expert opinion, consensus statements, animal studies
What characteristics should useful info sources include for clinicians?
Rapid access!
Targeted to specific clinical questions!
Up to date information!
Easy to use!
What is epidemiology?
Investigating a disease/disorder, which includes the factors that prove presence/absence of a disease, how disease changes, and how it affects us/society.
Why do we care about epidemiology?
Helps us plan and evaluate our strategies.
Guide management.
What are the common backgrounds for those working in epidemiology?
MD/DO
MPH
DrPH
PhD in population/public health
MS in epidemiology
Where do epidemiologists usually work?
Universities
CDC
Health Protection Agency
WHO
State/government public health agencies
What are the 3 types of research designs?
Descriptive studies
Analytic studies
Experimental studies
Where do I usually find epidemiological information for a disease?
In the beginning!
What can cause disease?
Nature and Nuture
What are the 4 major factors of disease?
Host: entity AFFECTED
Agent: entity CAUSING
Environment: Conditions
Vector: Method of transmission
What is the BEINGS model?
Biological/behavioral factors
Environmental factors
Immunological factors
Nutritional Factors
Genetic Factors
Services, Social, Spiritual
What is herd immunity?
Having enough of the population vaccinated against a disease such that the transmission to a non-vaccinated individual is near 0%.
What is the iceberg phenomenon?
If we have x cases of a disease diagnosed, how many MORE are undiagnosed?
What were 5 of the most common epidemic level diseases in the past 50 years?
Lyme disease
Toxic Shock Syndome
AIDS
SARS
COVID-19
Define a rate in epidemiology.
Rate is:
Events/Conditions of Concerns
divided by
the population at risk
What are the most common or critical events we typically measure?
Births, Deaths, Fetal Deaths, and Cause of Death
What are some major health databases?
US Vital Statistics System
National Notifiable Disease Surveillance System
National Center for Health Statistics (NCHS)
Behavioral Risk Factor Surveillance System
Disease Registries
Novel Registries
What types of diseases are usually reportable?
STDs, highly virulent diseases (COVID-19), or large impacts on public health
What are the fundamental measurements an epidemiologist needs?
Frequency:
Incidence: Frequency of occurrences of disease, injury, or death in the study population during the study’s time period.
Prevalence: Number of people with the current condition/case at that point in time. Involved with either point prevalence or period prevalence.
Which prevalence measure do we use?
Point prevalence.
Define risk in epidemiology.
Proportion of persons who are UNAFFECTED at the beginning, but undergo the risk event during the study.
Define risk event in epidemiology.
Anything from death to disease to injury.
Define cohort in epidemiology.
The persons at risk for the event in the beginning.
What is the case fatality ratio?
Proportion of clinically ill persons who die
What is infectiousness?
Proportion of exposed persons who become infected
Why do we care about the midperiod population?
Usually a good estimate of the average number of people at risk for the outcome during the study period. (Often the denominator)
What is incidence rate?
Number of cases over a defined study period
divided by
Population at risk at the MIDPOINT of that study period.
What is prevalence rate?
It is a proportion
Proportion of persons with a defined disease or condition at the time they are studied. (Percentage)
What are the 3 kinds of rates?
Crude rate
Specific rates
Standardized/Adjusted rates
How much of cases does primary/essential hypertension account for?
95%!
What is the rare cause of 0.1% of HTN cases?
Pheochromocytoma
