HaDSoc Flashcards
Define an adverse event
An injury caused by medical management rather than underlying disease, and that prolongs hospitalisation, produces disability or both
Describe the Swiss Cheese Model of Accident Causation (aka James Reason’s Framework of Error)
There are successive layers of defences, barriers and safeguards. However errors occur because of active failures that are acts that directly lead to the patient being harmed (e.g. drug overdose) or because of latent conditions (predisposing conditions which mean active failures are more likely e.g. poor training, poor supervision)
How does systems-based approach promote patient safety and quality in healthcare?
- Avoid reliance on memory
- Make things visible
- Review and simplify processes
- Standardise common processes and procedures
- Routinely use checklists
- Decrease reliance on vigliance
Define clinical governance
A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish
Define clinical audit
Quality improvement process seeking to improve patient care and outcomes through systematic review of care against criteria and implementation of change
Label the clinical audit cycle
Give examples of quantitative methods of research
- Questionnaires
- RCT
- Cohort studies
- Case-control studies
- Cross-sectional surveys
What are the advantages of using questionnaires?
Good for describing, measuring and finding relationships and allows for comparisons to be made
What are the disadvantages of using questionnaires?
- Force people into inappropriate categories
- Don’t allow people to express things in the way that they want
- May not be effective in establishing causality
Give some methods of qualitative research methods
- Observation and ethnography - studying human behaviour in nature context
- Interviews
- Focus groups
- Documentary and media analysis
What are the advantages of qualitative research methods?
- Understanding patient’s perspective
- Explaining relationships between variables
What are the disadvantages of qualitative research methods?
- Not good at finding consistent relationships between variables
- Not good for generalisability
What is the benefits of systematic reviews and meta-analysis?
- Help offer to highlight gaps in research and poor quality research
- Offer authorative, generalisable and up-to-date conclusions
- Save clinicans from having to locate and appraise the studies themselves
Explain the practical criticisms of EBP
- Impossible to create and maintain systematic reviews across all specialities
- Challenging and expensive to distribute and implement findings
- Choices of outcomes very biomedical - limits interventions trialled (e.g. complementary and alternative medicine)
- Requires ‘good faith’ in pharmaceutical companies
Explain philsophical criticisims of EBP
- Doesn’t align with most doctors’ mode of reasoning
- Population-level outcome may not apply to individual
- May make professionals ‘unreflective rule followers’
- Can be seen to be undermining the doctor-patient relationship and the NHS
What are some of the difficulties of getting evidence into practice?
- Evidence exists but doctors don’t know about it
- Doctors know evidence but don’t use it
- Organisational systems can’t support innovation
- Commissioning decisions reflect different priorities
- Resources not available to implement change
Explain the artefact explanation with regards to health inequalities and socio-economic background
Health inequalities are evident due to the way statistics are collected
Explain the social selection explanation with regards to health inequalities and socio-economic background
Sick individuals move down social hierarchy and health individuals move up (health status = social position rather than other way around)
Chronically ill and disabled people are more likely to be disadvantaged
Explain the behavioural-cultural explanation with regards to health inequalities and socio-economic background
Ill health due to people’s choices/decisions, knowledge and goals. Choices made freely from range of options
What are the limitations of the behavioural-cultural explanation?
- Behaviours and outcomes of social processes are not a simple individual choice
- Choices may be difficult to exercise in adverse conditions
- Choices may be rational for those whose lives are constrained by their lack of choices
Explain the materalist explanation with regards to health inequalities and socio-economic background
Inequalities in health arise from differential access to material resources (low income, unemployment, work environment)
Explain the difference between inequality and inequity
Inequality = when things are different e.g. men don’t get access to cervical screening
Inequity = inequalities that are unfair and avoidable
What is a lay belief?
How people understand and make sense of health and illness
Describe the negative, functional and positive definitions of health
Negative definition = absence of illness
Functional = ability to do certain things
Positive = state of well-being and fitness
Describe the illness iceberg
Only a small proportion of those infected with a pathogen may manifest symptoms and/or signs of illness
OR
Only a small percentrage of those will symptoms of ill-health will present to primary care
Describe what is meant by lay referral system
People will discuss their symptoms with others before or instead of presenting to the doctor. It can determine their decision to attend
What are the 5 main approaches of health promotion?
- Medical/preventative
- Behaviour change
- Educational
- Enpowerment
- Social change
Describe the different between primary, secondary and tertiary levels of health prevention
Primary = prevent onset of disease or injury by reducing risk factors e.g. smoking cessation
Secondary = Detect and treat a disease at early stage to prevent progression and future complications e.g. breast screening
Teritary = minimise effects of an established disease e.g. steroids for asthma
What are some of the dilemmas raised by health promotion?
- Ethics of interfering in people’s lives
- Victim blaming
- Fallcy of empowerment
- Reinforcing negative stereotypes
- Unequal distribution of responsibility
- The prevention paradox
Describe what is meant by the prevention paradox
- Interventions made at population level might not have effect at individual level
- People can still be at risk despite the intervention and people may not see themselves as a candidate so not participate
Describe the different types of work of chronic illness
- Illness work - manage the symptoms
- Everyday life work - coping and strategic management to deal with day-to-day life
- Emotional work - work done to protect emotional well-being of others
- Biographical work - loss of self, your future idea and image
- Identity work - different conditions carry different connotations, how people see themselves
Define stigma
Negatively defined condition, attribute, trait or behaviour conferring ‘deviant’ status.
Distinguish between discreditable and discredited stigma
Discreditable = not visible but would cause stigma if found out (HIV, mental health)
Discredited = physically visible characteristic or well-known stigma (physical diability, known suicide attempt)
Distinguish between felt and enacted stigma
Felt = fear of enacted stigma, encompasses a feeling of shame by having a condition
Enacted = real experience of prejudice, discrimination and disadvantage
What are the 8 factors that determine Health-related quality of life (HRQoL)?
- Physical function
- Symptoms
- Global judgements of health
- Psychological function
- Social wellbeing
- Cognitive functioning
- Personal constructs
- Satisfaction with care
Give an example of a quantitative method of measuring HRQoL
Short-form survey 36 (SF-36) - generic quality of life questions
What are the advantages of using generic quantitative methods for measuring HRQoL?
- Used for a broad range of health problems
- Used if no disease-specific instrument present
- Comparisons across treatment groups
- Used to detect unexpected positive or negative effects of interventions
- Assess health of population
What are the disadvantages of using a generic quantitative method for measuring HRQoL?
- Less detailed
- Loss of relevance
- Less acceptable to patients
Define screening
A systematic attempt to detect an unrecognised conition by using tests, examinations and other procedures
Used to rapidly distinguish between well people and whether they probably do or don’t have a disease
List the criteria required for implementing a screening programme relating to the disease/condition
- Must be an important health problem
- Acceptable to the population
- Must have an early detectable stage
- Cost-effective primary prevention interventions must have been considered
List the criteria required for implementing a screening programme relating to the test
- Simple, safe, precise, valid
- Acceptable to population
- Agreed cut-off level defined
List the criteria required for implementing a screening programme relating to the treatment
- Based on evidence based practice
- Early treatment must be adventageous
- Clinical mangement and patient outcomes optimised
List the criteria required for implementing a screening programme relating to the programme
Benefit should outweigh physical and psychological harm
Define false positive and false negative with regards to screening
False positive = people who do not have the disease that test positive
False negative = people who do have the disease that test negative
Define sensitivity
Proportion of people with the disease who test positive
A/(A+C)
Define specificity
Proportion of people without the disease that test negative
D/(B/D)
Define positive predictive value
How may people who have tested positive that actually have the disease
A/(A+B)
Define negative predictive value
How many people who tested negative actually don’t have the disease
D/(C+D)
Describe lead-time bias
Early diagnosis falsely appears to prolong survival, but patients live for same length, but longer knowing that they have the disease
Describe length-time bias
Screening programmes are better at picking up slow-growing, unthreatening cases that have a more favourable prognosis than the agressive, fast-growing ones.
Describe selection bias with regards to screening
Studies of screening often skewed by healthy volunteer effect. Those who go to screenings are likely to do other things that protect them from disease
Describe the difference between explicit and implicit rationing of health care resources
Explicit = based on defined rule of entitlement (transparent, accountable, EBP)
Implicit = care is limited but decisions or bases of these decisions is not well defined (open to abuse, lead to inequities and discrimination)
What is meant by opportunity cost?
Once you have used a resource in one way, you no longer have it to use in another way. Measured in benefits foregone.
Benefits of choices need to outweigh their opportunity cost
Describe cost-minimisation analysis with regards to comparing costs and benefits of resources
Assumes outcomes are equivalent, so focus on cost
Describe cost-effectiveness analysis with regards to comparing costs and benefits of resources
Compare drug or interventions that have same common health outcome - is extra benefit worth extra cost?
Uses a cost-effectiveness plane
Describe cost-benefit analysis with regards to comparing costs and benefits of resources
All inputs and outputs valued in monetary terms. Allows for comparisons with interventions outside healthcare. ‘Is it worth the money?’
Describe cost-utility analysis with regards to comparing costs and benefits of resources
Comparing interventions in cost per QALY terms
What is a QALY?
Quality-adjusted life years
1 QALY = 1 year of perfect health for one person
