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health outcomes research > Module 3 > Flashcards

Module 3 Flashcards

1
Q

Demographic, psychological, and social factors as variables (3)

A

Dependent variable- as outcome (ie marital status)

independent variable- impacts outcome- ie marital status and stress management

control variable- things you control for (ie severity of depression controlled for to determine impact of counseling on quality of life)

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2
Q

2 ways of conceptualizing age

A
  • as time since birth
  • As likelihood of dying “real age”
    • not good validity yet
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3
Q

2 ways to measure age

A

continuous variable- if constant effect

categorical variable- if inflection point where age effect is maximized

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4
Q

2 ways of conceptualizing residence (with details)

A
  • as location
    • indicator of access to health services
    • health exposure
    • rural v. urban
    • indirect measure of ses
  • as characteristics of dwelling or larger built environment
    • ex: stairs after hip surgery
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5
Q

Definition of race (historically)

A

population that lives within specified geographical area and has common gene pool

consider genotype v phenotype

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6
Q

Ecological fallacy (race)

A

attributing group characteristics to the individual

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7
Q

ethnicity

A

cultural factors that ID a person as part of a group, can’t ID from race

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8
Q

Marital status

A

civil arrangement with legal support

consider divisions (single, married, widowed, divorced)

looks at life stresses, emotional support, or can be an outcome itsenf

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9
Q

SES

A

looks at factors such as income, education, occupation (with different ways to code)

now moving from strategication and toward social capital

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10
Q

Tools to measure SES (3)

A
  • Hollingshead Index of Social Position
  • Duncan socioeconomic index
  • Nam-Powers Socioeconomic Score
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11
Q

Mind-body connection

And what it includes (4)

A

includes behavioral medicine, esp placebo effect

  • well being
  • locus of control
  • pain
  • stress
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12
Q

well being

A

ranges from emotional to economic well being

overlap with health related qulatiy of life

don’t measure specific health-well being relationship

more general in nature

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13
Q

Measures of well being (2)

A
  • General well being schedule
  • index of well being
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14
Q

Locus of control

A

most share internal and external aspects

outgrowth of mastery and efficacy

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15
Q

Measures of locus of control:

general (2)

health (2)

A

General

  • spheres of control battery
  • internality, powerful others, and chance scale

health

  • multidimensionality health locus of control scale
  • mental health locus of control scale
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16
Q

pain

A

frequently measured with VAS

difficult to compare across individuals

frequency and intensity most relevant

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17
Q

measures of pain (6)

A
  • brief pain inventory (location, severity, quality)
  • mcgill pain questinonaire (sensory nature of pain)
  • MOS Pain measure (pain and function)
  • Low Back Pain disability questionnaire
  • pain and distress scale
  • fatigue, energy, econsciousness, adn sleepiness
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18
Q

stress

A

emotional, physiologic, social, economic

perceived or experienced

consider :perception, stressful experiences, coping resources

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19
Q

stress measures (4)

A

perceived

  • perceived stress questionnaire

experiences

  • social readjustment rating scale
  • life stressors and social resources inventory
  • life stressor checklist
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20
Q

Other mind-body

A

nonfunctional adjustment (illness behavior questionnaire)

readiness to change

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21
Q

Affect

A

construct validity very important

consider: responsiveness, diagnosis v. behavior/perception

anxiety and depression with biggest focus

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22
Q

depression

A

most prevalent mental health problem in us

related to loneliness and social isolation

some tools target specific populations, others environmental factors

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23
Q

depression tools (5)

A
  • self rating depression scale
  • center for epidemiologic studies depression scale
  • geriatric depression scale
  • carroll rating scale
  • depressive experiences questionnaire
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24
Q

anxiety

A

range of defniitions from situational and well defined to vague state experienced

recent focus on state v. trait

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25
Q

state v. trait anxiety

A

state=transitory experience, short term

trait=stable, persistant response to environmental factors

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26
Q

anxiety tools

A
  • self rating anxiety scale
  • hamilton anxiety scale
  • state trait anxiety measure
  • endler multidimensional anxiety scale
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27
Q

Other affect considerations (with tools-3)

A

general affect or morale or positive emotions

  • affect balance scale
  • memorial university of newfoundland scale of happiness
  • PGC morale scale
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28
Q

cognitive function

A

doesn’t measure IQ

addresses judment, memory, ability to perform interpretive and related tasks

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29
Q

cognitive function tools (2)

A
  • mini mental state exam
  • short portable mental status questionnaire
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30
Q

social function

A

ability to fulfill roles

giving and receiving help

dependent on roles held previously

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31
Q

social support

A

can be objective (how many hours) or subjective (level of need, feelings about it)

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32
Q

social support measures (4)

A

social support questionnaire

MOS social support survey

duke-unc functional social support survey

duke social support and stress scale

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33
Q

social function and adjustment

A

individual’s status and function

long tools due to complexity

take positive or maladaptive approach

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34
Q

social function and adjustment tools (4)

A

social functioning schedule

social adjustment schedulue

social maladjustment scale

social dysfunction scale

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35
Q

complex organizations

A

looks at aspects of jobs, such as commitment and work control

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36
Q

what is a treatment?

A

an intervention designed to improve a health state

could be a cure or prevention, procedure, drug, behavior change, how health care is delivered

any potential modifiable factor

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37
Q

components of care

A

goal is to standardize intervention

consider level of specification and what you will emphasisize depending on area of focus

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38
Q

Treatment components (3)

A

Medication, prodedure, counseling/education

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39
Q

7 elements of tx

A

type

dosage

route

frequency

duration

onset/timing

provider characteristics/technical aspects

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40
Q

diagnosis v. treatment

A

each can be a component of tx

pay attention to diagnsosi when it has an impact on treatment (ie if diagnosing depression means that it’s more severe to start with, or that someone is more likely to have a stigma against it or something like that)

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41
Q

treatment components: medications

A

anything taken into body tha timpacts health status

can be drug, supplement, nutrition

consider: type, dosage, route, frequency, duration, onset/timing

NOT provider

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42
Q

treatment components: procedures

A

anything physically done to pt

consider: type, frequency, duratino, onset/timing, technical aspects/provider

NOT: dosage or route

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43
Q

treatment components: counseling

A

exchange of info for therapeutic purpose

consider type, dosage, frequency, duration, onset/timing, provider

NOT route

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44
Q

clinical guidelines

A

help standardize tx

must be adapted to ind. pt needs

is making the guideline part of the tx?

how are they implemented?

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45
Q

isolating tx of interest

A

use comparison group

analyze change over time relative to when intervention implemented

utilize placebo for “attention control”

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46
Q

quality improvement

A

special kind of intervention

highly contextualized, so may have to treat it differently

47
Q

challenge to compare interventions

A

hard to do less effective intervention (extant data?)

adherance

48
Q

treatment summary (3)

A
  1. understand the components of tx
  2. include variation in tx- comparison
  3. understand tha teffect of tx is difference in groups after everythign else is controlled for
49
Q

risk adjustment

A

takes into account pt attributes for making valid inferences about effectiveness and quality of care

50
Q

examples of risk adjustors

A

age

sex

gender

race

ethnicity

acute clinical stability

principal diagnosis

severity

comorbidity

functional status

hrqol

51
Q

severity

A

classify pt’s primary problem in terms of prognosis

ex: APACHE: Acute physiological score, age, chronic health eval
ex: repeated hospital admissions
ex: DRG

52
Q

comorbidity with 3 reasons to measure

A

coexisting conditions unrelated to principal diagnosis

Not equal to complications

  1. control for selection bias
  2. predict outcomes
  3. form basis for subgroup analysis
53
Q

examples of diagnosis specific severity measure (3)

A

AHA Stroke outcome classification

Canadian neurological scale

low back classification system

54
Q

ways to measure comorbidity

A

can list dummy coding

can list only salient ones

can weight them

can consider severity of comorbidities

55
Q

why control for comorbidity? (3)

A

control for selection bias

improve prediction of outcomes

form a basis for subgroup analysis

56
Q

data sources for risk adjustment (3)

A

medical records- not always complete, time consuming to abstract data

admin data- easier, but designed to maximize reimbursement

medications prescribed- as proxy, but flawed

57
Q

considerations in selecting risk adjustment strategy (4)

A

purpose

relative importance of diagnosis to risk

data realted considerations

Role of competing risks

58
Q

increasing reliability in data for risk adjustments (5)

A

clarity of definition

operationalized definition

extent of quality of data- review, completeness, etc

training of reviewers

environment of review

59
Q

statistical performance

A

look for goodness of fit, predictive validity, model discrimination

60
Q

Uses of ICD codes (7)

A
  1. Workload and length of stay tracking
  2. Quality of care
  3. VA- allocate resources to medical centers
  4. Study patterns of disease, care, and outcomes
  5. Effectiveness of care (risk adjusted)
  6. Inclusion and exclusion criteria
  7. Rate reporting
61
Q

original use of ICD codes

A

classify causes of death, then adopted by WHO

62
Q

Sources of error along patient trajectory

A
  • communication between patient and admitting clerk/clinicians
  • Clinician’s knowledge of best tests
  • Clinician’s ability to interpret results
  • Recording of diagnosis
  • Changes in diagnostic accuracy over time
63
Q

sources of errof along the paper trail (ICD codes)

A
  • synonyms used in record
  • omissions in medical record
  • transcription in medical record
  • incomplete info when chart is reviewed
  • coder training
  • coder experience and attention
  • miscoding (generic for specific)
  • resequencing codes (primary diagnosis)
  • upcoding (for reimbursement)
  • errors at attestation by physician
64
Q

5 ways to view code accuracy

A
  1. sensitivity
  2. specificity
  3. positive predictive value
  4. negative predictive value
  5. K coefficient
65
Q

3 things required in order for race/ethnicity measurs to be meaningful

A
  1. produce consistent data over time
  2. allow comparability across populations and surveys
  3. use terms that are widely understood by the groups completing the instruments
66
Q

race as biology?

A

more variation within races than between

race exists as socio-political construct rather than biological one

67
Q

race and racism?

A

race is social construct that INCLUDES the effects of racism on an individual

racism includes institutionalized racism and internalized racism

68
Q

institutionalized racism

A

having differential levels of access based on race to societal goods, services, and opportunities

educational and access racism

69
Q

internalized racism

A

feelings of resignation, helpflessness, and hopelessness

can lead to risky health behaviors

70
Q

ethnicity

A

cultural identification

can be fluid over time

can influence health beliefs

71
Q

ways of measuring race and ethnicity:

revised directive number 15

A

5 categories of race, can pick more than 1

hispanic/nonhispanic

72
Q

ways to measure race/ethnicity:

census 2000

A

allow multiple responses to categories, some confusion over specificying hispanic ethnicity

73
Q

ways to measure race/ethnicity:

sillitoe survey

A

added religion item to get at ethnicity- did not chagne responses

74
Q

ways to measure race/ethnicity:

stephenson multigroup acculturation scale

A

looks at degree of acculturation

not designed to measure cultural change among acculturating individuals

factors: ethnic society immersion, dominant society immersion

75
Q

5 research goals related to race/ethnicity

A
  1. look at outcomes related to race ethnicity
  2. disentangle ses from race/ethnicity
  3. effects of racism on different groups realted to outcomesrationale for collection of race/ethnicity data
  4. manner in which data was collected could be reported
76
Q

treatment fidelity

A

methodological strategies used to monitor and enhance the reliability and validity of behavioral interventions

goal is to increase confidence that changes in dependent variable are due to changes in independent variable

77
Q

best practice for treatment fidelity (5 categories)

A

design

training

delivery

receipt

enactment

78
Q

treatment fidelity: design

A

factors that should be considered when designing a trial and factors that should be reported in order to evalute and replicate the trial

example: content and dose for tx and comparison conditions, provider credentials, theoretical framework

79
Q

treatment fidelity: training

A

if using human providers, consider capability of delivering intervention , training, measurement of provider skill acquiasition and how skills are maintained over time

80
Q

treatment fidelity: treatment delivery

A

processes of monitoring and improving the delivery of the intervention

mechanism to assess how treatment is delivered

look for impact of provider

81
Q

treatment receipt

A

ensuring that the participants understand ino provided

(ie literacy, cognitive level, English language, etc)

82
Q

treatment fidelity: treatment enactment

A

processes to monitor and improve teh ability of patients to perform treatment realted cognitive strategies and behabioral skills in their daily lives

83
Q

importance of treatment fidelity study

A

give consumers a way to evaluate

give researchers a plan

give more guidelines for RCTs and funding

84
Q

Comorbidity measures

A

Charlson- assigns weights related to hospital mortality, have caution with ICD9 codes, weight different for different populations, no reason to conlude that it’s comprehensive

Elixhauser comorbidity index- broader applications

The list created in the study we read:

allows DRG filter for comorbidities (to exclude complications), comorbidities predict resources utilized better than mortality

85
Q

5 concepts that represent burden of illness

A
  1. primary diagnosis
  2. severity of primary diagnsois
  3. complications that arise from process of care
  4. unimportant comorbodities
  5. important comorbidities (that are unreatled to main reason for hospitalization) but increase likelihood of poor outcome
86
Q

what is attribution bias?

A

falsely attributing an aspect of an outcome to one cause, when it may have been due to another

87
Q

how can you lessen attribution bias in outcomes research?

A

make sure that comparison groups are very well matched and defined

RISK ADJUST!

88
Q

what is sampling bias?

A

In statistics, sampling bias is when a sample is collected in such a way that some members of the intended population are less likely to be included than others.

89
Q

What is recruitment bias?

Give one source

A

Recruitment bias is a cause of sampling error due to methods used to recruit participants into a study.

Possible sources: how the study is advertised (phone calls v. mailers v. posters, convenience studies, stopping people on the street, from a clinic, etc)

90
Q

What is assignment bias?

Give one source

A

Assignment bias would occur anytime something is done that results in people systematically being assigned to a treatment.

For example, if you’re assigning people based on treatment received, maybe it is impacted by setting (ie academic v. nonacademic med setting)

91
Q

What is intention to treat?

How can it be used in studies in which noncompliance is believed to be a problem?

A

an analysis based on the initial treatment intent, not on the treatment eventually administered. ITT analysis is intended to avoid various misleading artifacts that can arise in intervention research

Help estimate what will happen “in real world,” though it may understimate actual efficacy of treatment

92
Q

what is selection bias

A

Selection bias is a statistical bias in which there is an error in choosing the individuals or groups to take part in a scientific study

93
Q

what is a selectivity corrected model?

A

A model that has either been risk adjusted or used propensity scores to equate groups.

94
Q

Treatment setting as proxy

A

Potentially:

Insurance status (inpt v no)

Severity (locked psych unit v. outpatient)

SES (transportation)

95
Q

Should all elements of treatments be measured in a single study

A

You should measure each of them that are relevant so as to idolate the treatment of interest as much as possible.

Consider #s involved in study.

96
Q

distinguish among the different components of severity

A

general physiological severity (regardless of diagnosis)- likelihood of mortality

functional component- degree of impairment

relation of baseline condition to condition at different measured times

97
Q

3 types of severity measures

A

APACHE

CNS

AHA Stroke Outcome Classification

98
Q

2 most common time points at which severity is measured (with disadvantages)

A

admission- can be at different points in illness (ie on the way up v. on the way down)

discharge- often impacted b things like insurance

99
Q

How can one identify components of severity to avoid selection bias?

A

Look at the if the severity of illness is associated with outcome

AND

if severity of illness is associateed with treatment but is not a conseuence of the treatment

100
Q

5 criteria to choose severity measure

A

covers appropriate domains

appropriate for time point in which it’s being utilized

specific enough to allow for risk adjustment

valid in the population in which it’s being utilized

differentiates between complications and comorbidities

101
Q

4 severity of illness measures and one example of when each would be used

A

APACHE-II, if you’re determining risk of death in ICU patients

Probability of repeated hospital admissions- to identify elderly patients who might benefit from a comprehensive evaluation

AHA Stroke Outcome Classification- to impairment, severity, and functional classification through the assessment of 6 domains after a stroke

Canadian Neurological Scale= to predict patient outcomes and ID symptoms specific to acute stroke.

102
Q

determining comorbidity v. complication

A

literature review

DRG

timing- comorbidities present at onset, compications arise during the episode

103
Q

why do a subgroup analysis when examing comorbidity?

A

looks at influence of effect of comorbodity on response to treatment (interaction effect)

104
Q

why are disease of primary interest and prognostic end points factors in choosing and measuring comorbidity?

A

help you decide how to consider comorbidity- all of them, salient ones, weighted, etc, based on likelihood that they will impact the outcome of interest

105
Q

1 advantage of a weighted comorbidity approach

A

lets you control more for the comorbidities that are likely to ahve the biggest impact on outcome

106
Q

Charleson and Duke- explain and one example of when it might be good to use as comorbidity tool

A
107
Q

gender v. sex

A

Sex refers to biological differences; chromosomes, hormonal profiles, internal and external sex organs.

Gender describes the characteristics that a society or culture delineates as masculine or feminine.

Which one used should depend on why you’re measuring the construct at all.

108
Q

advantage of composite ses index?

A

the use of a composite ses index can help to ensure that you are actually measuring the intended underlying contstruct v. just proxies of that construct.

109
Q

list at least 3 depression scales and give an advantage

A

Geriatric depression scale- speciically for administration in geriatric populations in the clinical setting

carroll rating scale- assesses severity of depression by specifically identifying 17 symptoms associated with depression; self-rating, easy- yes/no questions

beck depression inventory- allows for measurement of change over time because it evaluates depth of the depression

110
Q

list at least 2 psychological well being scales and give an advantage and disadvantage of each

A

general well-being schedule- developed for the national center for health statistics, this is intended to measure well being in the general population

The GWB Schedule is good for group studies of subjective well-being but less is known regarding its adequacy as a case-detection instrument.

index of well being- composed of eight semantic differential items and one life satisfaction item

looks at health states and rates their importance (societal view)

each can miss situational issues

111
Q

comorbidity measures (2)

A

Charlson Comorbidity Index- weighte dcomorbidity score to predict hospital mortality (relative risk)., also available in ambulatory care; disadvantage- narrow application

elixhauser comorbidity index- broader application across a range of conditions and outcomes

112
Q

Duke Severity of Illness Checklist

A

four parameters of a health problem: symptoms, complications, 6-months prognosis without treatment, treatment potential. T

he following three types of severity score (from 0 [lowest degree of severity] to 100 [highest degree of severity]) can be calculated: (1) the DUSOI diagnosis score for each diagnosis stated, (2) the DUSOI overall score for the set of all health problems stated for a patient, and (3) the DUSOI comorbidity score, i.e., all problems except for any one problem of principal interest.

The DUSOI is suitable for patients from the entire chain of medical and rehabilitative care, although it had initially been developed for the ambulatory sector

113
Q
A

health outcomes research (2 decks)

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