Exam 1 Flashcards
Demography, US Healthcare, HIT, HIPAA, Healthcare History
What is demography?
Demography is the statistical study of human populations.
What are the 3 contributing components to population change?
Death, birth, and immigration
What is the estimated increase in life expectancy for males and females in 2060?
85 for females and 80 for males
In developed nations, what is the minimum total fertility rate to maintain population stability?
2.3 children per woman as of 2023 is the replacement rate.
Where is the US fertility rate in relation to the minimum rate?
The minimum rate is 1.61 in Europe. The US sits at 1.7 births per woman.
What is the trend in US fertility rates between 1960 and 2020?
In 1960, birth rates were 3.7 births/woman. In 2020, birth rates were 1.7 births/woman. This is a decreasing trend in fertility.
What is the trend in world fertility rates between 1960 and 2020?
Overall world fertility rates have decreased between these times. It is not as significant as the US.
How does a decreasing fertility rate impact the population?
Declining birth rates alter to population by lowering the population that will fills jobs to take care of the growing elderly population, pay into social security and more.
What are the contributing factors to the lower birth rates in the US?
Delaying birth, price and current economy, careers, birth control and abortions, and higher socioeconomic status and education.
What are the population implications/ consequences of the decline in fertility and birth rates in the US?
Less individuals paying in social security. Less candidates for jobs, more weight on the healthcare system as the elderly turn to homes instead of family.
What is a demographic transition?
Demographic transition is the pattern of population change. It is how a population moves from high birth and death rates to low birth and death rates.
What stage of demographic transition is the US currently in?
US is in stage 4 of the demographic transition. Stage 4 is low birth rates and low death rates which is current to the US. Median age has increased 3.5 years since 2000.
Explain each population period shape in terms of birth and death rate.
Stage 1- High BR, High DR
Stage 2- High BR, Rapidly declining DR
Stage 3- Falling BR, Slow decline DR
Stage 4- Low BR, Low DR
Stage 5- Unknown BR, Low DR
When is the net international migration projected to become the largest driver of population growth in the US?
By the year 2030, net international migration is said to be the largest driver of population growth in the US.
Describe the projected population change trends from 2020-2060.
White (non-hispanics) will fall below 50% of the population (44.3%). Large increases in the hispanic population (17.8% to 27.5%). Small increases in the African American, Native American, and Hawaiian populations.
What are 3 implications for healthcare due to the population changes between 2020 and 2060?
- More knowledge on geriatric population
- More knowledge on diverse populations. What conditions effect them at higher rates?
- Increased healthcare costs and jobs as elderly population increases
What are the trends in US healthcare spending?
US healthcare spending has continued to increase and they will get more expensive.
What are the 3 highest categories of healthcare spending in the US?
- Hospitals
- Physicians and Clinics
- Prescription drugs
Who are the #1 and #2 payers for prescription drugs in the US?
Private insurance and then medicare
Is it true that other wealthy countries (OECDs) spend about 1/2 as much per person on healthcare than the US?
Yes. The US spends around $12,000 per person while the average for OCEDs is $5,700 per person.
Does the US have the highest life expectancy compared to OECD countries?
No. The life expectancy in the US is 76 years while the average of OECD countries is 82 years.
Where does the US rank in its overall healthcare system ranking in comparison with OECD countries?
We rank the worst in everything for all countries except in our care process which is ranked 2nd.
Does the US have the highest rates of death due to healthcare errors?
Yes, the US has 336/100,000 deaths per year while the average for OECD countries is 225.
Does the US have the most practicing physicians and physician consultants?
No, the US has 2.6 physicians for 1,000 people and 4 physician consultants per 1,000 people.
What country spends the most on administrative costs for healthcare?
The US!!! We spend almost triple the amount compared to all other OECDs.
What country has the highest price for prescription drugs?
The US!
What is the Flexner Report?
Report to form cohesive medical standards for the US and Canada. Established a formal curriculum for medical students. Overall, it streamlined the education for future physicians.
How is the Flexner report related to pharmacy?
The Flexner report stated that the pharmacist obeyed the physician as they were the main person responsible for patients. It was written in 1910, and by 1922, the APA released a code stating that pharmacist were to handle, sell, collect, and dispense medications. They were not allowed in interact with patients or collect, assess, and plan medication use.
What was the transition of hospitals between the late 19th century (lates 1800s) and 20th century (1900s)?
In the beginning, the hospitals that did exist where seen as a place where people when to die. The upper class found medications and cures at drugstores whereas the lower class use plants and other materials to create home remedies. By the time of the civil war in 1861, the medical field began to advance. Through trial and error, more hospitals were created and germ theory replaced Galen’s system of therapeutics. With time, aseptic techniques, surergy, anesthesia, and X-rays were being used to care for patients.
What was the inception of employer-based insurance?
Employer-based insurance was developed as a way to combat wage controls imposed by the US government during WWII. During the war, the labor market was tight. There was still an increased demand for goods and a shortage of workers. Since the wages of workers could not be increased to incentivize them, companies began attaching benefits to jobs including what is now known as healthcare insurance.
What was the role of Kaiser, Blue Cross, and Blue Shield in the inception of employer-based insurance?
Kaiser was a man that convinced Garfield to open a hospital near the Grand Coulee Dam in order to treat workers. Kaiser paid the hospital an initial amount to take care of the workers, and the workers paid him a fee to cover those healthcare costs. This generated what is known as preventative healthcare. Baylor University provided teachers 21 days of hospital coverage at a fee of fifty cents per month. This became known as the Blue Cross. This idea was expanded to include physician fees and was known as Blue Shield. These novel ideas in paying ahead of time and making sure all people were covered continued into the present as current healthcare insurance.
What was proposed by President Truman and who opposed his purposal?
President truman proposed a national healthcare program that would streamline all medical processes. This would include payments for all Americans. However, it was strongly opposed by the American Medical Association and was called a communist plot.
What was the Health Maintenance Organization Act?
The Health Maintenance Organization Act was a program that was aimed at improving access to care and care quality as well as lowering the cost. It was also required for businesses employing more than 25 people. It set standards and gave funds to start organizations focused on health maintenance. It was approved in 1973. This act was passed in response to the cost of healthcare increasing rapidly as well as issues in exploitation of insurance companies.
What are the types of quality measures?
Effective, safe, timely, patient-centered, equitable, and effiacious
P.E.E.E.T.S
What is a quality indicator?
A quality indicator is a physical measurement that reflects the care being provided.
What is quality performance?
Quality performance is what is being evaluated by the quality indicators. It is how well that care and other factors are given and applied to patients.
What is a quality measure?
A quality measure is a tool like a survey or a goal of achievement that assesses the care being given. Quality measures are used to evaluate quality performance.
What is the differences between quality indicators, performances, and measures?
Quality indicators are a physical measurement of the care that evaluates quality performance. Quality performance is also evaluated by quality measures like surveys.
What are the 3 key ways that quality of healthcare is reported?
Clinical performance measures- assess the organization, healthcare plans there and the healthcare providers
Patient ratings- patient rates the visit
Outcome of care
CPO
What is being evaluated on the quality of care delivered to patients?
The quality of care delivered to patients that is evaluated is done so by looking at those measures that directly influence the outcome of the patient.
What is accreditation?
Accreditation is the process by which a certification of competency, authority, or credibility, is presented to an organization.
Who accredits community pharmacies?
The accrediting bodies for community pharmacies include the Utilization Review Accreditation Commission (URAC) and Center for Pharmacy Practice (CPPA).
What is Pay-4-Performance?
Pay-4-Performance is the idea of paying healthcare providers to give more focused, detailed and high-quality care to patients. This program incentivizes providers to give quality care to patients.
What is PQA?
The PQA is the pharmacy quality alliance.
What do PQAs do?
The pharmacy quality alliance offers accreditation and quality measures specific to pharmacy. They measure medication therapy management and its impact on patient outcomes.
What are the PQA quality measures?
The PQA measures of quality include medication adherence, medication management, safety, quality, and patient outcomes. All measures are related to inpatient and outpatient pharmacy settings.
MA
MTM
S
Q
O
MMSQO
Define EQuiPP.
EQuiPP is a quality improvement software for pharmacies.
Who provides the EQuiPP platform?
Innovaccer. However, the organization that runs the pharmacy should provide this platform.
What do the letters in the S-P-O framework stand for?
S- Structure
P- Process
O- Outcome
How is S-P-O applied in medication therapy management?
In medication management, the S in SPO means looking over the patient medication profile. The P in SPO means review the profile of the patient. Finally, the O in SPO means no adverse events.
What is CAHPS?
CAHPS is the consumer assessment of healthcare providers and systems program. This program sends out surveys to patients to collect information regarding their provider’s performance during the visit and the organization as a whole. The goal of CAHPS to to inform providers and organizations about the quality of care that is being provided to the patients.
How is the S-P-O framework applied?
SPO is the basic framework on how to improve the practice and pharmacy. Structure is the physical aspect of the pharmacy including the programs used, the employers, training, and more. Process is how the care is provided at the pharmacy. This includes proper consulting for patients and adequate care. Finally, outcome is how the pharmacy impacts patients.
What are the CMS quality measures associated with pharmacy practice?
The quality measured used for quality measurements in pharmacy practice made by the CMS, Centers for Medicare and Medicaid Services, include adherence to medications, medication therapy management and reconciliation, preventative care, the star rating out of five, and outcomes
MA
MTM+R
Preventative Care
/5
Outcomes
MMP5O
What is patient-centerdness?
Patient-centeredness means being respectful and responsive to the patient and acknowledging and providing to their wants needs, and values.
What does HEDIS do?
HEDIS is the health plan employee data information set. It is provided by the NCQA (National Committee for Quality Assurance). It measures performance on the important dimensions of care and service for healthcare organizations. Examples of measurement could include immunization status and comprehensive diabetes care in different age groups.
What does HEDIS measure?
HEDIS measures performance on the important dimensions of care and service for healthcare organizations. Examples of measurement could include immunization status and comprehensive diabetes care in different age groups.
Define quality according to IOM.
The IOM has defined quality as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
What is the difference between quality and value?
Value is a broader concept that incorporates quality and the cost. It describes how much a person is willing to give based on how thorough they believe the service is. On the other hand, quality is the standard of care which includes the patient experience, treatment by physician, and overall experience at the organization.
What are the laws and regulations specific to patient privacy for health information technology?
The Health Information Portability and Accountability Act of 1996 (HIPAA), regulate electronic transmission of protected health information. Additional provisions include the privacy rule and security rule.
What did the privacy rule add to HIPAA in 2000?
The privacy rule stated that there are standards and rules to allow an individual to protected health information (PHI). The HIPAA privacy rule is a federal law that seeks to safeguard privacy rights of an individual’s health information.
What did the security rule add to HIPAA in 2003?
The security rule established standards for administrative, technical, and physical security control for covered entities.
What is HIPAA?
HIPAA is the health information portability and accountability act of 1996. HIPAA established standards for electronic transmission of health information.
Compare federal and state law for privacy rights regarding an individual’s health information.
Sometimes state laws offer more stringent protection for protected health information. Whichever law gives PHI greater protection or allows a patients greater access to their PHI should be followed.
What is the individual information identified as protected health information?
PHI is any identifying information that is connected to a specific person. PHI includes names, geographic information, dates (except for years), telephone/fax numbers, email, SSN, medical record number, health plan beneficiary number, license number, account number, vehicle identifies, device identifies, URLs, biometrics, and full face photographic images.
What group is predicted to be the biggest threat to data security breaches?
The biggest threat to data security breaches include phishing attacks.
What are the consequences of HIPAA violations?
HIPAA violations subject organization and individuals to civil and criminal sanctions including fines and prison.
What is information security?
Information security includes confidentiality, integrity, and accessibility. Information security is important to maintain the integrity and availability of data when patient health and safety are involved.
Why does compliance matter?
Compliance matters as it ensures organizations and health systems conduct business in a legal and ethical manner.
What are the necessary safeguards needed to exchanges health information securely?
- Administrative safeguards
- Physical safeguards
- Technical safeguards
What are administrative safeguards needed to exchange health information securely?
Implementation of policies and procedures for authorizing access to PHIs. Policies that establish, document, review, and modify a user’s right to access a workstation or program.
What are physicial safeguards needed to exchange health information securely?
Limit physical access to electronic information systems or facilities. Protect information from natural disasters. Shield screens.
What are technical safeguards needed to exchange health information securely?
Technical safeguards include q unique use login and passwords and emergency access to PHIs.
Define health information technology.
Health information technology is the exchange of health information in an electronic environment.
Why do we need health information technology?
Health information technology is needed to improve the quality of healthcare, prevent medical errors, and reduce healthcare costs.
Who governs health information technology?
HIT is governed by the Office of the National Coordinator for Health Information Technology (ONC) which is within the Department of Health and Human Services (HHS)l
What is an EMR?
EMR is the electronic medical record. This is the digital version of a paper chart and is the health information within one organization.
What is an EHR?
EHR is the electronic health record. This is the digital version of a paper chart but it spans across more than one healthcare organization.
What is a PHR?
PHR is personal health record. PHR is the same as the electronic health record but it controlled by the individual patients.
What is the pharmacist’s role in informatics?
The pharmacist in informatics include information management, knowledge delivery, data analytics, clinical informatics, and leadership.
What are possible future uses for health information exchanges?
