Health System

Question 1

Describe the Clinical Translational Science Concept of T1>T2>T3

Answer 1

T1 = Taking Biomedical Science and Seeing "Does it work" clinically
T2 = Who Benefits from Promising Care = Outcomes Studies, Comparative Effectiveness Research, Health Services Research
T3 = How to deliver clinically effective technologies = Quality and Cost studeis, How to disseminate, etc.

Question 2

How many randomized controlled trials are published per year?

Answer 2

25,000

up from 5,000 in the 1970’s. This emphasizes the need for guildelines. Docs can’t keep up.

Question 3

What are Jordan’s Data Collection Categories of Workflow Analysis?

Answer 3

1) Person-Oriented Record: Understand work of a person in a specific role
2) Object-Oriented Record: Artifact Oriented: Trace the path of a medical record document understanding its role in collaboration
3) Setting_oriented Record (event-oreinted) What happens in the OR when starting a case
4) Task-Oriented Record: Go through the whole medication administration procedures

Question 4

What are “Structural” quality measures?

Answer 4

Attributes of a care setting that mane quality care likely: a) Number of specialists for a given population or b) Number of clinical guidelines implemented

Question 5

What are “Process” quality measures?

Answer 5

Measures of how care is actually delivered. E.g. Percent of children who are fully immunized by 2 years of age.

Question 6

What are Outcome measures–intermediate versus End?

Answer 6

Intermediate: HbA1c or Lipid Profile results for patients with hyperlipidemia

Final = Quality of Life for pts with cancer
or Patient Satisfaction or Survival Rate

Question 7

Describe how to do a Failure Mode and Effects Analysis

Answer 7

1) Map out process using a flowchart diagram
2) For each step describe what happens if the process fails
3) Rate each failure according to
a) Severity of harm
b) Likelihood of occurrence
c) Detect-ability (giving a pregnancy test to a male is very detectable versus admin of a paralytic is not detectable)
4) Calculate Risk Priority Number. Prioritize those failures that are Severe, Likely, and Not Detectable

Question 8

Define the five elements of a Patient Centered Medical Home

Answer 8

1. Comprehensive Care
   The primary care medical home is accountable for meeting the large majority of each patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care. Providing comprehensive care requires a team of care providers. This team might include physicians, advanced practice nurses, physician assistants, nurses, pharmacists, nutritionists, social workers, educators, and care coordinators. Although some medical home practices may bring together large and diverse teams of care providers to meet the needs of their patients, many others, including smaller practices, will build virtual teams linking themselves and their patients to providers and services in their communities.
2. Patient-Centered
   The primary care medical home provides primary health care that is relationship-based with an orientation toward the whole person. Partnering with patients and their families requires understanding and respecting each patient’s unique needs, culture, values, and preferences. The medical home practice actively supports patients in learning to manage and organize their own care at the level the patient chooses. Recognizing that patients and families are core members of the care team, medical home practices ensure that they are fully informed partners in establishing care plans.
3. Coordinated Care
   The primary care medical home coordinates care across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports. Such coordination is particularly critical during transitions between sites of care, such as when patients are being discharged from the hospital. Medical home practices also excel at building clear and open communication among patients and families, the medical home, and members of the broader care team.
4. Accessible Services
   The primary care medical home delivers accessible services with shorter waiting times for urgent needs, enhanced in-person hours, around-the-clock telephone or electronic access to a member of the care team, and alternative methods of communication such as email and telephone care. The medical home practice is responsive to patients’ preferences regarding access.

5.Quality and Safety
The primary care medical home demonstrates a commitment to quality and quality improvement by ongoing engagement in activities such as using evidence-based medicine and clinical decision-support tools to guide shared decision making with patients and families, engaging in performance measurement and improvement, measuring and responding to patient experiences and patient satisfaction, and practicing population health management. Sharing robust quality and safety data and improvement activities publicly is also an important marker of a system-level commitment to quality.