first aid Flashcards
Observational studies Study type: Case series
Design: Describes several individual patients with the same diagnosis, treatment, or outcome.
Measures/Example: Description of clinical findings and symptoms. Has no comparison group, thus cannot show risk factor association with disease.
Observational studies
Study type: Cross-sectional study
Frequency of disease and frequency of risk-related factors are assessed in the present.
Measures/Example: Asks, “What is happening?” Disease prevalence. Can show risk factor association with disease, but does not establish causality.
Observational studies
Study type: Case-control study
Design: Retrospectively compares a group of people with disease to a group without disease.
Measures/Example: Asks, “What happened?” Odds ratio (OR). Control the case in the OR. Patients with COPD had higher odds of a smoking history than those without COPD.
Observational studies
Study type: Cohort study
Design: Compares a group with a given exposure or risk factor to a group without such exposure.
Measures/Example: Looks to see if exposure or risk factor is associated with later development of disease. Can be prospective or retrospective. Disease incidence. Relative risk (RR). People who smoke had a higher risk of developing COPD than people who do not. Cohort = relative risk.
Observational studies
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Study type: Twin concordance study
Design: Compares the frequency with which both monozygotic twins vs both dizygotic twins develop the same disease.
Measures/Example: Measures heritability and influence of environmental factors (“nature vs nurture”).
Observational studies
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Study type: Adoption study
Design: Compares siblings raised by biological vs adoptive parents.
Measures/Example: Measures heritability and influence of environmental factors.
Observational studies
Study type: Ecological study
Design: Compares frequency of disease and frequency of risk-related factors across populations.
Measures/Example: Measures population data not necessarily applicable to individuals (ecological fallacy). Used to monitor population health. COPD prevalence was higher in more polluted cities.
Design: Describes several individual patients with the same diagnosis, treatment, or outcome.
Observational studies Study type: Case series
Frequency of disease and frequency of risk-related factors are assessed in the present.
Measures/Example: Asks, “What is happening?”
Observational studies
Study type: Cross-sectional study
Design: Retrospectively compares a group of people with disease to a group without disease.
Observational studies
Study type: Case-control study
Design: Compares a group with a given exposure or risk factor to a group without such exposure.
Observational studies
Study type: Cohort study
Compares the frequency with which both monozygotic twins vs both dizygotic twins develop the same disease.
Observational studies
Back of card:
Study type: Twin concordance study
Design: Compares siblings raised by biological vs adoptive parents.
Observational studies
Back of card:
Study type: Adoption study
Design: Compares frequency of disease and frequency of risk-related factors across populations.
Observational studies
Study type: Ecological study
Phase 1 clinics
- Small number of healthy volunteers
- Determine safety, dosage, side effects
- Assess pharmacokinetics and pharmacodynamics
Phase 2 clinical trials
- Larger number of patients with the condition/disease studied
- Assess if treatment has therapeutic effect
- Determine optimal dosage and explore adverse effects
Phase 3 clinical trial
- Large-scale study with randomized treatment and control groups
- Evaluate treatment efficacy, safety, and dosing under normal clinical conditions
- Typically involves hundreds to thousands of patients
Phase 4 clinical trial
- Post-marketing surveillance after drug approval
- Long-term safety and efficacy monitoring
- Observational studies, registries, and adverse event reporting
phase 5 clinical trial
- Continual monitoring of drug in general population
- Evaluate long-term safety and effectiveness
- Compare treatment with other available interventions
Crossover study
Definition: Compares the effect of a series of ≥2 treatments on a participant. Order in which participants receive treatments is randomized. Washout period occurs between treatments.
Allows participants to serve as their own controls.
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Bradford Hill criteria
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Definition: A group of principles that provide limited support for establishing evidence of a causal relationship between presumed cause and effect.
Definition: A group of principles that provide limited support for establishing evidence of a causal relationship between presumed cause and effect.
Bradford Hill criteria
Bradford Hill criteria
Strength:
- Association does not imply causation, but the stronger the association, the more evidence for causation
Bradford Hill criteria Consistency:
Repeated observations of the findings in multiple distinct samples.
Bradford Hill criteria
Strength:
Association does not imply causation, but the stronger the association, the more evidence for causation
Bradford Hill criteria
Consistency
Repeated observations of the findings in multiple distinct samples.
Bradford Hill criteria
Specificity
The more specific the presumed cause is to the effect, the stronger the evidence for causation
Bradford Hill Criteria:
Temporality
The presumed cause precedes the effect by an expected amount of time.
Bradford Hill Criteria: Biological gradient
Greater effect observed with greater exposure to the presumed cause (dose-response relationship).
Bradford Hill Criteria:
Plausibility
A conceivable mechanism exists by which the cause may lead to the effect
Bradford Hill Criteria: Coherence
The presumed cause and effect do not conflict with existing scientific consensus.
Bradford Hill Criteria: Experiment
Empirical evidence supporting the presumed cause and effect (eg, animal studies, in vitro studies).
Bradford Hill Criteria: Analogy
The presumed cause and effect are comparable to a similar, established cause and effect.
Odds ratio
Typically used in case-control
studies. Represents the odds of
exposure among cases (a/c) vs odds
of exposure among controls (b/d).
OR = 1 odds of exposure are
equal in cases and controls.
OR > 1 odds of exposure are
greater in cases.
OR < 1 odds of exposure are
greater in controls.
Relative risk
Typically used in cohort studies.
Risk of developing disease in the
exposed group divided by risk in
the unexposed group.
RR = 1 no association between
exposure and disease.
RR > 1 exposure associated with
disease occurrence.
RR < 1 exposure associated with disease occurrence.
Relative risk
reduction
The proportion of risk reduction
attributable to the intervention as
compared to a control.
Attributable
risk
.
The difference in risk between
exposed and unexposed groups
Absolute
risk
reduction
The difference in risk (not the
proportion) attributable to the
intervention as compared to a
control.
Number
needed to
treat
Number of patients who need to
be treated for 1 patient to benefit.
Lower number = better treatment.
Number
needed to
harm
Number of patients who need to
be exposed to a risk factor for 1
patient to be harmed. Higher
number = safer exposure.
Case fatality
rate
Percentage of deaths occurring
among those with disease.
Mortality
rate
Number of deaths (in general or
due to specific cause) within a
population over a period, typically
scaled to deaths per 1000 people
per year
Attack rate
Proportion of exposed people who
become ill.
Likelihood ratio
Sensitivity (true-positive rate
Proportion of all people with disease who test
positive, or the ability of a test to correctly
identify those with the disease.
Value approaching 100% is desirable for ruling
out disease and indicates a low false-negative
rate.
Specificity (true-negative rate
Proportion of all people without disease who
test negative, or the ability of a test to correctly
identify those without the disease.
Value approaching 100% is desirable for ruling
in disease and indicates a low false-positive
rate
Positive predictive
value
Probability that a person who has a positive test
result actually has the disease.
Negative predictive
value
Probability that a person with a negative test
result actually does not have the disease
Receiver operating
characteristic curve
ROC curve demonstrates how well a diagnostic
test can distinguish between 2 groups (eg,
disease vs healthy). Plots the true-positive rate
(sensitivity) against the false-positive rate
(1 – specificity).
The better performing test will have a higher
area under the curve (AUC), with the curve
closer to the upper left corner
Precision (reliability)
The consistency and reproducibility of a test. The absence of random variation in a test
Random error decrease precision in a test.
high precision = decrease standard deviation.
increased precision = increased statistical power (1 − β)
Accuracy (validity)
The closeness of test results to the true values. The absence of systematic error or bias in a test.
Systematic error decrease accuracy in a test.
Incidence
Prevalence
Increase in survival time causes what for incidence & prevalence
doesn’t effect incidence & increase prevalence
Increase in mortality time causes what for incidence & prevalence
no change in incidence & decreased prevalence
Faster recovery time causes what for incidence & prevalence
No change in incidence & decreased prevalence
Extensive vaccine administration causes what for incidence & prevalence
Decreased incidence & decreased prevelance
Decreased risk factors causes what for incidence & prevalence
decreased incidence & prevalence
Increased diagnostic sensitivity causes what for incidence & prevalence
Increased incidence & prevalence
Selection bias
Nonrandom sampling
or treatment allocation
of subjects such that
study population is not
representative of target
population
Most commonly a sampling
bias
Nonrandom sampling
or treatment allocation
of subjects such that
study population is not
representative of target
population
Most commonly a sampling
bias
Selection bias
Berkson bias (selection bias)
cases and/
or controls selected from
hospitals (bedside bias) are
less healthy and have different
exposures
Attrition bias (selection bias)
participants lost
to follow up have a different
prognosis than those who
complete the study
Recall bias
Awareness of disorder alters
recall by subjects; common in
retrospective studies
Measurement bias
Information is gathered in a
systemically distorted manner
Procedure bias
Subjects in different groups are
not treated the same
Observer-expectancy
bias
Researcher’s belief in the
efficacy of a treatment changes
the outcome of that treatment
(aka, Pygmalion effect)
Researcher’s belief in the
efficacy of a treatment changes
the outcome of that treatment
(aka, Pygmalion effect)
Observer-expectancy
bias
Subjects in different groups are
not treated the same
Procedure bias
Measurement bias
Information is gathered in a
systemically distorted manner
Recall bias
Awareness of disorder alters
recall by subjects; common in
retrospective studies
Attrition bias (selection bias)
participants lost
to follow up have a different
prognosis than those who
complete the study
Attrition bias (selection bias)
participants lost
to follow up have a different
prognosis than those who
complete the study
Berkson bias (selection bias)
cases and/
or controls selected from
hospitals (bedside bias) are
less healthy and have different
exposures
Confounding bias
Factor related to both exposure
and outcome (but not on
causal path) distorts effect
of exposure on outcome (vs
effect modification, in which
the exposure leads to different
outcomes in subgroups
stratified by the factor)
Factor related to both exposure
and outcome (but not on
causal path) distorts effect
of exposure on outcome (vs
effect modification, in which
the exposure leads to different
outcomes in subgroups
stratified by the factor)
Confounding bias
Lead-time bias
Early detection interpreted as
increased survival, but the disease
course has not changed
Early detection interpreted as
increased survival, but the disease
course has not changed
Lead-time bias
Length-time bias
Early detection interpreted as
increased survival, but the disease
course has not changed
Early detection interpreted as
increased survival, but the disease
course has not changed
Length-time bias
Length-time bias
Screening test detects diseases
with long latency period,
while those with shorter
latency period become
symptomatic earlier
Screening test detects diseases
with long latency period,
while those with shorter
latency period become
symptomatic earlier
Length-time bias
Measures of central
tendency: Most affected by outliers (extreme values).
Mean = (sum of values)/(total number of values)
Measures of central
tendency: middle value of a list of data sorted
from least to greatest
Median
Measures of central
tendency: Least affected by outliers
Mode = most common value
Measures of
dispersion: Standard deviation =
how much variability
exists in a set of values, around the mean of
these values.
Advance directives
Instructions given by a patient in anticipation of the need for a medical decision
Oral advance directive
Incapacitated patient’s prior oral statements commonly used as guide. Problems arise from variance
in interpretation. If patient was informed, directive was specific, patient made a choice, and
decision was repeated over time to multiple people, then the oral directive is more valid
Written advance
directive
Delineates specific healthcare interventions that patient anticipates accepting or rejecting during
treatment for a critical or life-threatening illness. A living will is an example
Medical power of
attorney
Patient designates an agent to make medical decisions in the event that the patient loses decisionmaking capacity. Patient may also specify decisions in clinical situations. Can be revoked by
patient if decision-making capacity is intact. More flexible than a living will
Do not resuscitate
order
DNR order prohibits cardiopulmonary resuscitation (CPR). Patient may still consider other lifesustaining measures (eg, intubation, feeding tube, chemotherapy)
Surrogate decisionmaker
If a patient loses decision-making capacity and has not prepared an advance directive, individuals
(surrogates) who know the patient must determine what the patient would have done. Priority of
surrogates: spouse adult children parents siblings other relatives
(the spouse ChilPS in)
Examples of exceptions to patient confidentiality (many are state specific) include the following
(“The physician’s good judgment SAVED the day”)
Patients with Suicidal/homicidal ideation
Abuse (children, elderly, and/or prisoners)
Duty to protect—state-specific laws that sometimes allow physician to inform or somehow
protect potential Victim from harm
Patients with Epilepsy and other impaired automobile drivers
Reportable Diseases (eg, STIs, hepatitis, food poisoning); physicians may have a duty to warn
public officials, who will then notify people at risk. Dangerous communicable diseases, such as
TB or Ebola, may require involuntary treatment.
Expressing empathy PEARLS
Partnership - Assure the patient of working together and provide appropriate resources.
Empathy - Acknowledge and understand the patient’s emotions.
Apology - Take responsibility or offer condolences when appropriate.
Respect - Commend patients for their behavior or attitude.
Legitimization - Assure the patient that emotional responses are understandable.
Support - Offer assistance during difficult times.
Delivering bad news SPIKES:
Setting - Ensure privacy and eliminate distractions.
Perception - Understand the patient’s understanding and expectations.
Invitation - Ask for permission to disclose the news and desired level of detail.
Knowledge - Share information in small pieces without medical jargon.
Emotions - Acknowledge and allow expression of emotions.
Strategy - Discuss treatment options and goals of care, offer an agenda for the next appointment.
Gender and sexuality-inclusive history taking:
Avoid assumptions and use gender-neutral terms.
Recognize that assigned sex and gender identity may differ.
State your pronouns and ask patients how they would like to be addressed.
Reassure confidentiality and acknowledge sensitivity.
Only bring up gender or sexuality if relevant to the visit.
Trauma-informed communication:
Screen for behavioral health and assess mood, substance use, and social supports.
Focus on trauma-related symptoms affecting functioning.
Avoid invasive questions about trauma details.
Reassure patients they can end the physical exam if uncomfortable and offer additional support.
Motivational Interviewing:
A counseling technique to help patients resolve ambivalence about behavior change. Useful for various conditions such as nicotine dependence and obesity.
Assessing Readiness for Change: SMART
Important for setting physician-suggested goals. Goals should be SMART (Specific, Measurable, Achievable, Relevant, and Time-bound)
Communicating with Patients with Disabilities:
Use person-first language. Ask patients about their preferred terms. Talk directly to the patient and include caregivers if necessary.
Providing Assistance:
Ask if assistance is desired instead of assuming incapability. Respect patients’ independence.
Speech Difficulties:
Provide extra time and ask patients to write down or rephrase their words if necessary. Repeat to ensure understanding.
Cognitive Impairment:
Use concrete language, ask direct questions, eliminate distractions, and adjust to the patient’s preferred understanding method.
Deaf or Hard of Hearing Patients:
Ask about their preferred mode of communication. Use light touch or waving to get their attention.
Disability Relevance:
Do not bring up a disability if not relevant. Perform a complete physical exam regardless of any challenges posed by the disability.
Use of Interpreters:
Utilize professionally trained medical interpreters for patients with limited English proficiency. Confirm patient preference for family member interpretation.
Respectful Communication:
Make eye contact, speak directly to the patient, and avoid third-person statements. Allow extra time and ask one question at a time.
Patient is not adherent.
Identify and assess any barriers that may hinder the patient’s adherence, including financial, logistical, or other obstacles. Do not force or persuade the patient to adhere, nor recommend them to another doctor.
Patient desires an unnecessary
procedure
Attempt to understand why the patient wants the procedure and address underlying
concerns. Do not refuse to see the patient or refer to another physician. Avoid
performing unnecessary procedures
Patient has difficulty taking
medications
Determine what factors are involved in the patient’s difficulties. If comprehension or
memory are issues, use techniques such as providing written instructions, using the
teach-back method, or simplifying treatment regimens.
Family members ask for information
about patient’s prognosis
Avoid discussing issues with relatives without the patient’s permission.
A patient’s family member asks you
not to disclose the results of a test
if the prognosis is poor because
the patient will be “unable to
handle it.”
Explore why the family member believes this would be detrimental, including
possible cultural factors. Explain that if the patient would like to know information
concerning care, it will not be withheld. However, if you believe the patient might
seriously harm self or others if informed, you may invoke therapeutic privilege and
withhold the information
A 17-year-old is pregnant and
requests an abortion
Many states require parental notification or consent for minors for an abortion. Unless
there are specific medical risks associated with pregnancy, a physician should not
sway the patient’s decision for, or against, an elective abortion (regardless of patient’s
age or fetal condition). Discuss options for terminating the pregnancy and refer to
abortion care, if needed.
A 15-year-old is pregnant and wants
to raise the child. Her parents
want you to tell her to give the
child up for adoption.
The patient retains the right to make decisions regarding her child, even if her parents
disagree. Provide information to the teenager about the practical aspects of caring
for a baby. Discuss options for terminating the pregnancy, if requested. Encourage
discussion between the teenager and her parents to reach the best decision
A terminally ill patient requests
physician-assisted dying.
The overwhelming majority of states prohibit most forms of physician-assisted dying.
Physicians may, however, prescribe medically appropriate analgesics even if they
potentially shorten the patient’s life.
Patient is suicidal
Assess the seriousness of the threat. If patient is actively suicidal with a plan, suggest
remaining in the hospital voluntarily; patient may be hospitalized involuntarily if needed
Patient states that you are attractive
and asks if you would go on a date.
Use a chaperone if necessary. Romantic relationships with patients are never
appropriate. It may be necessary to transition care to another physician
A woman who had a mastectomy
says she now feels “ugly.”
Find out why the patient feels this way. Do not offer falsely reassuring statements (eg,
“You still look good”).
Patient is angry about the long time
spent in the waiting room
Acknowledge the patient’s anger, but do not take a patient’s anger personally. Thank
the patient for being patient and apologize for any inconvenience. Stay away from
efforts to explain the delay.
Patient is upset with treatment
received from another physician
Suggest that the patient speak directly to that physician regarding the concern. If the
problem is with a member of the office staff, tell the patient you will speak to that
person
An invasive test is performed on the
wrong patient
Regardless of the outcome, a physician is ethically obligated to inform a patient that a
mistake has been made
A patient requires a treatment not
covered by insurance.
Discuss all treatment options with patients, even if some are not covered by their
insurance companies. Inform patient of financial assistance programs
A 7-year-old boy loses a sister to
cancer and now feels responsible.
At ages 5–7, children begin to understand that death is permanent, that all life
functions end completely at death, and that everything that is alive eventually
dies. Provide a direct, concrete description of his sister’s death. Avoid clichés and
euphemisms. Reassure the boy that he is not responsible. Identify and normalize fears
and feelings. Encourage play and healthy coping behaviors (eg, remembering her in
his own way).
Patient is victim of intimate partner
violence.
Ask if patient is safe and help devise an emergency plan if there isn’t one. Educate
patient on intimate partner violence resources. Do not necessarily pressure patient to
leave a partner or disclose the incident to the authorities (unless required by state law).
Patient wants to try alternative or
holistic medicine.
Explore any underlying reasons with the patient in a supportive, nonjudgmental
manner. Advise the patient of known benefits and risks of treatment, including
adverse effects, contraindications, and medication interactions
Physician colleague presents to
work impaired.
This presents a potential risk to patient safety. You have an ethical and usually a legal
obligation to report impaired colleagues so they can cease patient care and receive
appropriate assistance in a timely manner. Seek guidance in reporting as procedures
and applicable law vary by institution and state
Patient is officially determined to
suffer brain death. Patient’s family
insists on maintaining life support
indefinitely because patient is still
moving when touched.
Gently explain to family that there is no chance of recovery, and that brain death is
equivalent to death. Movement is due to spinal arc reflex and is not voluntary. Bring
case to appropriate ethics board regarding futility of care and withdrawal of life
support
A pharmaceutical company offers
you a sponsorship in exchange for
advertising its new drug.
Reject this offer. Generally, decline gifts and sponsorships to avoid any conflict of
interest. The AMA Code of Ethics does make exceptions for gifts directly benefitting
patients; special funding for medical education of students, residents, fellows; grants
whose recipients are chosen by independent institutional criteria; and funds that are
distributed without attribution to sponsors
Patient requests a nonemergent
procedure that is against your
personal or religious beliefs.
Provide accurate and unbiased information so patients can make an informed decision.
In a neutral, nonjudgmental manner, explain to the patient that you do not perform
the procedure but offer to refer to another physician.
Mother and 15-year-old daughter
are unresponsive following a
car accident and are bleeding
internally. Father says do not
transfuse because they are
Jehovah’s Witnesses.
Transfuse daughter, but do not transfuse mother. Emergent care can be refused by the
healthcare proxy for an adult, particularly when patient preferences are known or
reasonably inferred, but not for a minor based solely on faith
A dependent patient presents
with injuries inconsistent with
caretaker’s story.
Document detailed history and physical. If possible and appropriate, interview the
patient alone. Provide any necessary medical care. If suspicion remains, contact
the appropriate agencies or authorities (eg, child or adult protective services) for an
evaluation. Inform the caretaker of your obligation to report. Physicians are required
by law to report any reasonable suspicion of abuse, neglect, or endangerment.
A pediatrician recommends standard
vaccinations for a patient, but the
child’s parent refuses.
Address any concerns the parent has. Explain the risks and benefits of vaccinations
and why they are recommended. Do not administer routine vaccinations without the
parent’s consent
Primary disease
prevention
Prevent disease before it occurs (eg, HPV vaccination)
Secondary disease
prevention
Screen early for and manage existing but asymptomatic disease (eg, Pap smear for cervical cancer)
Tertiary disease
prevention
Treatment to reduce complications from disease that is ongoing or has long-term effects
(eg, chemotherapy)
Quaternary disease
prevention
Quit (avoid) unnecessary medical interventions to minimize incidental harm (eg, imaging studies, optimizing medications to reduce polypharmacy)
Exclusive provider
organization
Restricted to limited panel
(except emergencies)
No referral required
Health maintenance
organization
Restricted to limited panel
(except emergencies)
Most affordable
Requires referral from
primary care provider
Point of service
Patient can see providers
outside network
Higher copays and
deductibles for out-of-network services
Requires referral from
primary care provider
Preferred provider
organization
Patient can see providers
outside network
Higher copays and
deductibles for all services
No referral required
Accountable care
organization
Providers voluntarily enroll
Medicare
Specialists voluntarily enroll
Healthcare payment models:
Bundled payment
Healthcare organization receives a set amount per service, regardless of ultimate cost, to be divided
among all providers and facilities involved.
Healthcare payment models: Capitation
Physicians receive a set amount per patient assigned to them per period of time, regardless of how
much the patient uses the healthcare system. Used by some HMOs.
Healthcare payment models: Discounted fee-for-service
Insurer and/or patient pays for each individual service at a discounted rate predetermined by
providers and payers (eg, PPOs).
Healthcare payment models: Fee-for-service
Insurer and/or patient pays for each individual service
Healthcare payment models: Global payment
Insurer and/or patient pays for all expenses associated with a single incident of care with a single
payment. Most commonly used during elective surgeries, as it covers the cost of surgery as well as
the necessary pre- and postoperative visits
Medicare and
Medicaid
MedicarE is for Elderly.
MedicaiD is for Disadvantaged.
The 4 parts of Medicare:
The 4 parts of Medicare:
Part A: hospital Admissions, including
hospice, skilled nursing
Part B: Basic medical bills (eg, physician
fees, diagnostic testing)
Part C: (parts A + B = Combo) delivered by
approved private companies
Part D: prescription Drugs
PDSA cycle
Process improvement model to test changes in
real clinical setting. Impact on patients:
Plan—define problem and solution
Do—test new process
Study—measure and analyze data
Act—integrate new process into workflow
Quality measurements: Structural
Structural: Physical equipment, resources, facilities
ex. Number of diabetes educators
Quality measurements: Process
Performance of system as planned
ex. Percentage of patients with diabetes whose
HbA1c was measured in the past 6 months
Quality measurements: Outcome
Impact on patients
ex. Average HbA1c of patients with diabetes
Quality measurements: Balancing
Impact on other systems/outcomes
ex. Incidence of hypoglycemia among patients who
tried an intervention to lower HbA1c
Swiss cheese model
Focuses on systems and conditions rather than
an individual’s error. The risk of a threat
becoming a reality is mitigated by differing
layers and types of defenses. Patient harm can
occur despite multiple safeguards when “the
holes in the cheese line up.”
Types of medical
errors: Active error
Occurs at level of frontline operator (eg, wrong
IV pump dose programmed) Immediate impact
Types of medical
errors: Latent error
Occurs in processes indirect from operator but
impacts patient care (eg, different types of IV
pumps used within same hospital). Accident waiting to happen
Types of medical
errors: Never event
Adverse event that is identifiable, serious, and
usually preventable (eg, scalpel retained in a
surgical patient’s abdomen). Major error that should never occur.
Types of medical
errors: Near miss
Unplanned event that does not result in harm
but has the potential to do so (eg, pharmacist
recognizes a medication interaction and
cancels the order) Narrow prevention of harm that exposes dangers
Prolonged, excessive stress cynicism, detachment, motivation and interest, sense of failure and
helplessness, immunity. Medical errors due to reduced professional efficacy
Burnout
Sleep deprivation energy and motivation, cognitive impairment. Medical errors due to
compromised intellectual function
Fatigue
Medical error analysis: Root cause analysis
Retrospective approach. Applied after failure
event to prevent recurrence.
Uses records and participant interviews to identify
all the underlying problems (eg, process,
people, environment, equipment, materials,
management) that led to an error
Root cause analysis
Medical error analysis: Failure mode and
effects analysis
Forward-looking approach. Applied before
process implementation to prevent failure
occurrence.
Uses inductive reasoning to identify all the ways
a process might fail and prioritizes them by
their probability of occurrence and impact on
patients
Failure mode and
effects analysis
Leading Causes of Death by Age Group (across Sex and Ethnic Group):
Infants (<1 y of age)
Congenital anomalies
Prematurity/low birth weight
Sudden infant death syndrome (SIDS)
Leading Causes of Death by Age Group (across Sex and Ethnic Group):
Children (1–4 y of age)
Accidents (in motor vehicles and in the home)
Congenital anomalies
Cancer (primarily leukemia and central nervous system [CNS] malignancies)
Leading Causes of Death by Age Group (across Sex and Ethnic Group):
Children (5–14 y of age)
Accidents (most in motor vehicles)
Cancer (primarily leukemia and CNS malignancies)
Suicide
Leading Causes of Death by Age Group (across Sex and Ethnic Group):Adolescents and young adults
(15–24 y of age)
Accidents (most in motor vehicles)
Suicide
Homicide and legal intervention
Leading Causes of Death by Age Group (across Sex and Ethnic Group):Adults (25–44 y of age)
Accidents (most in motor vehicles)
Cancer
Heart disease
Leading Causes of Death by Age Group (across Sex and Ethnic Group):Adults (45–64 y of age)
Cancer
Heart disease
Accidents (most in motor vehicles)
Leading Causes of Death by Age Group (across Sex and Ethnic Group):Elderly (65 y of age and over)
Heart disease
Cancer
Chronic lower respiratory diseases
Medicaid (MediCal in California)
Indigent (very low-income)
people
One-third of allfunds is allocated
for nursing home care for
indigent elderly people
Medicare
The federal government
(through the Social
Security system
People eligible for Social
Security benefits (e.g., those
at least 65 y of age regardless
of income)
People of any age with chronic
disabilities or debilitating
illnesses
Medicare
The federal government
(through the Social
Security system:
Part A:
Inpatient hospital care, home health care,
medically necessary nursing home care (for up to
90 days after hospitalization), hospice care
Medicare
The federal government
(through the Social
Security system:
Part B:
Part B: Physician fees, dialysis, physical therapy,
laboratory tests, ambulance service, medical
equipment (Part Bis optional and has a 20%
co-payment and a $100 deductible)
Medicare
The federal government
(through the Social
Security system: Part D
Part D: Is optional and covers a share of prescription
drug costs
Medicare does not cover long-term nursing home care
Point of service plan (POS)
Variant of a PPOin which a third-party payer
contracts with physicians in private practice to
provide medical care to its subscribers
Physicians in the network receive capitation for
each patient
