Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PRHS I - OMS I > PRHS I Final > Flashcards

PRHS I Final Flashcards

1
Q

study of how care is delivered

A

health systems science

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

understanding how healthcare professionals, with difference scopes and roles, work together to deliver care

A

health systems science

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Identifying ways in which the health system can improve patient care and delivery

A

health systems science

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

why is it important to understand health systems science now?

A
  • Rapid changes and challenges in healthcare
  • Technology and ease of access
  • Expanding and diverse patient populations
    • Underserved
    • Very young and very old
    • Chronic illnesses
    • Co-morbidities
  • Old style of diagnosis and treatment won’t do moving forward
  • Care must be patient-focused and quality delivery
  • Must remain adaptive
  • Directly affect your billing and revenue
  • There are federal, state, and contractual laws you do not want to violate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Triple Aim

A
  • Population Health
  • Experience of Care
  • Per Capita Cost

Triple PEP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Quadruple Aim

A
  • Population Health
  • Care Experience
  • Lowest Possible Cost
  • Healthcare Professional Wellness

qUad includes Us

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

definition of healthcare quality

A

STEEEP:

  • Safe
  • Timely
  • Effective
  • Efficient
  • Equitable
  • Patient-Centered
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Core Functional Domains include:

A
  • Patient, Family, Community
  • Health Care Structure and Process
  • Health Care Policy and Economics
  • Clinical Informatics and Health Technology
  • Population, Public, and Social Determinants of Health
  • Value in Health Care
  • Health Systems Improvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Patient, Family, Community core functional domain includes:

A
  • behaviors
  • experience (previous surgery of self or family member)
  • values
  • influence from others
  • motivations (money, shortened life span)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Health Care Structure and Process core functional domain includes:

A
  • all elements of how care is provided
  • individuals, institutions, resources, and processes for delivery
  • collaboration, coordination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Health Care Policy and Economics core functional domain includes:

A
  • Decisions, plans, and actions
  • Looking to meet specific health care goals
  • Involves efficiency, effectiveness, value, and behavior relative to production and consumption of health care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical Informatics and Health Technology core functional domain includes:

A
  • Application of informatics and technology to deliver services of health care
  • Clinical decision support
  • Documentation
  • Technology and tools
  • Utilization of data to improve health
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Population, Public, and Social Determinants of Health core functional domain includes:

A
  • Issues related to traditional public health, preventative medicine
  • Encompasses entire population, not just sick patients
  • Improvement for an entire population, identification of gaps
  • Organized assessment, monitoring, measurement
  • Prevention of disease and injury, promotion of health, prolongation of life
  • Aimed at groups of individuals, communities, ethnic groups, etc.
  • Includes access and distribution of outcomes, interrelationships amongst personal, socioeconomic, environmental factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  • Fear related to previous procedure or illness
  • Large co-pay to see a specialist
  • Will family bring patient back for follow-up
  • Does the prospect of a shortened life and co-morbidities motivate to stop smoking, manage diabetes, blood pressure
  • Unwilling to get a flu shot because it made other family members ill

examples of which core functional domain

A

Patient, Family, Community

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  • Knowledge of clinical settings
  • Inpatient vs outpatient requirements
  • Fragmented or insufficient care encountered along continuum
  • Ability to identify the need for teamwork and health care communities

examples of which core functional domain

A

Healthcare Structure and Process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  • History and core principles of health care policy
  • Basics of how care is financed and the impact on insurance and reimbursement
  • Incentives for providers and hospitals within different US payment models.

examples of which core functional domain

A

Healthcare Policy and Economics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
  • Core principles of informatics sciences
    • Biomedical
    • Patient security and rights protection
  • Real-time data viewing and decision support
    • Data registries
    • Clinical report analyzation
  • Functionality and challenges in current health information exchange

examples of which core functional domain

A

Clinical Informatics and Health Technology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q
  • Identification of common risk factors among a certain group
  • Cultural skills training for providers

examples of which core functional domain

A

Population, Public, and Social Determinants of Health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Value in Health Care core functional domain includes:

A
  • Performance of a health system in terms of quality of care
    delivery, cost, waste, service requirements
  • Understanding epidemiology, identifying and classifying gaps in care or delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
  • Stakeholder definition and perspective of value in health care
  • Components of high-value health care systems
  • Correlations between quality/safety and patient outcomes
  • Identification, reporting, and analyzation of safety events
  • Relationship between quality and cost, and efforts to address

examples of which core functional domain

A

Value in Health Care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Health Systems Improvement core functional domain includes:

A
  • Content related to identification, analyzation, or implementation of changes in policy, health care delivery, or by function that improves the performance of any component of the system
  • Also related to scholarship approach –
    • discovery that is consistent with traditional research, integration across disciplines
    • Application demonstrating interaction between research, practice, teaching
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q
  • Quality improvement project
  • Interprofessional education

examples of which core functional domain

A

Health Systems Improvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Foundational Domains include:

A
  • Change Agency, Management, and Advocacy
  • Ethics and Legal
  • Leadership
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Change Agency, Management, and Advocacy

foundational domain includes:

A
  • Knowledge and skills of health care professionals enable a higher quality of care
  • Agents of change to improve systems
  • Advocate for patients to receive best care possible
  • Knowledge of how other health care professionals can impact and change the system
  • Possess skills to advocate for patients at multiple levels
  • Identify and address barriers to change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Ethics and Legal foundational domain includes:

A
  • Ethical and legal issues, factors involved in health care delivery and health systems science
  • Relationship between law and ethics in the design and operation of health care in the United States
  • Understand transition underway that moves us from one-patient-one-doctor, to one doctor supporting a team, organization, or population – this is a systems approach
  • Challenges for health law and ethics with this approach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Leadership foundational domain includes:

A
  • Inspiration and motivation
  • Team-based care
  • QI projects
  • What skills are needed to become a true leader
  • Personal goals, life goals
  • Alignment between personal and institutional values
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Collaboration and team science includes:

A
  • Working together to achieve shared goals
  • Interprofessional education
  • Understanding the roles and skills of others
  • Communication at a higher level in an integrated/coordinated system
  • Possess skills to function in a team
  • Application of reflective practice relative to quality improvement and patient safety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Linking Domain

A

Systems Thinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Content that links the core domains and subcategories to contents of the broader medical school curriculum

A

Linking Domain: Systems Thinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Ability to apply a comprehensive, holistic approach to care and health care issues

A

Linking Domain: Systems Thinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Awareness of the whole, not just the parts

A

Linking Domain: Systems Thinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Recognize multidirectional cause-and-effect relationships

A

Linking Domain: Systems Thinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

“Health systems science consists of knowledge and concepts that are ___-centric rather than ___-centric.”

A

patient;

physician

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

which framework:

Patients do not heal or recover in isolation. As physicians work to understand their patients diagnostically, physicians are also being asked to consider the patient’s psychological and social conditions to have the greatest impact on processes and outcomes of care.

A

Bio-Psycho-Social (BSP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

which framework:

System theories suggest that every level of organization (molecular, cellular, organic) affects every other levels such as personal, interpersonal, familial and societal. These systems are not independent of each other but instead work together to produce desired outcomes of care.

A

Bio-Psycho-Social (BSP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Systems Thinking in healthcare include:

A

Patient-centered, surrounded by provider system, patient’s system, and healthcare system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

clinic, hospital, office, admin and processes

part of which system in systems thinking

A

provider system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

family, friends, communities, faith-based groups, personal resources

part of which system in systems thinking

A

patient’s system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

clinical programs, centers, hospitals, group practices, specialists, integrated systems

A

healthcare system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

process failure with current (broken) system

A
  • patient becomes ill, injured, needs care
  • PMD, walk-in clinic, ED, Telehealth
  • insurance? restrictions where patient can be seen?
  • HC provider assesses, gathers info, examines
  • are additional modalities required? labs, imaging, monitoring, urgent med administration?
  • communication of working diagnosis
  • treatment plan (Rx, PT, procedure, repeat imaging or labs, specialists, education supplies)
  • outcomes? was safe, HQ care provided? effectiveness?
  • follow-up and referrals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

“The complex US health care system is not the product of a deliberate, thoughtful, coordinated, and evidence-based approach to maximizing the health of a society. “

A

health care delivery system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

why is there a need for change in our current healthcare system?

A
  • poor integration of care
  • payment misalignment
  • unnecessary variation in care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

poor integration of care includes:

A 
academic, 
public, 
private, 
for profit, 
nonprofit, 
community-based, 
specialty-based, 
government-based, 
medical homes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

payment misalignment includes:

A
  • the more you do for a patient, the more the provider, institution, etc., is compensated
  • Fee-for-service model
  • Misallocation of resources and waste
  • Reimbursement happens regardless of efficacy or value
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

unnecessary variation in care includes:

A
  • the foundation is that of an “apprentice” model - Focus is centered on individual learning and preferences of the master teacher
  • This leaves patient outcomes dependent upon the individual physician and apprentice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what to do about this variation in care

A
  • Healthcare has been compared to other industries
  • What can be learned from an airline company or the hospitality industry
  • Institute of Medicine (IOM), “To Err is Human.”
  • “Silence Kills”
  • “The Josie King Story”
  • What do you think about when you hear, “Care Pathways,” “Evidence-Based Practice,” “Standards of Care?”
  • what about professionalism, the art of medicine, compassion, individual needs, trusting relationships?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

legislation includes:

A
  • value based payment
  • Affordable Care Act of 2010 (ACA)
  • Medicare Access and CHIP Reconciliation Act of 2015 (MACRA)
  • Merit-Based Incentive Payment System (MIPS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q
  • Providers accountable for performance
  • Measures quality, service, cost
  • Financial penalties and rewards
A

value based payment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q
  • Expanded eligibility for Medicaid

- “The Exchange,” individuals and small groups could purchase insurance

A

Affordable Care Act of 2010 (ACA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

legislated new provider performance metrics and payment models

A

Medicare Access and CHIP Reconciliation Act of 2015 (MACRA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

provides additional pay based on hitting targets for quality, safety, using EHRs, etc.

A

Merit-Based Incentive Payment System (MIPS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

responsible for the federal healthcare laws

A

Congress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

examples of federal healthcare laws

A

HIPAA, EMTALA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

goal of mandates and legislation

A
  • Improve and reward higher quality of care delivered
  • Lower costs
  • Improve outcomes in care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

The Joint Commission includes:

A
  • patient care and safety
  • higher quality staff
  • fulfill local and state requirements
  • satisfies CMS
  • liability insurance rates, contracts with insurance payors,
  • quality care and confidence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

provision of care through newer models reason

A

push toward higher quality care, at a lower cost, and better outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Newer Models for Provision of Care include:

A
  • Patient Care Medical Homes (PCMH)

- Accountable Care Organizations (ACOs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

which newer model for provision of care includes:

  • Coordinated, ongoing care
  • Health maintenance and wellness
  • Acute and chronic health care needs
  • Team based model
  • Optimizing roles
A

Patient Care Medical Homes (PCMH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

which newer model for provision of care includes:

  • Fragmented care = errors and gaps in quality and care
  • Provider-led, manage the entire continuum of care, costs, quality of care for a defined population
  • A sort of “medical home”
A

Accountable Care Organizations (ACOs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

CMS Accountable Care Performance Requirements

A
  • High value system
  • Meets goals of patients
  • Meets goals of Triple Aim
  • Timely measurement to evaluate quality of care provided
  • Alignment between financial metrics and performance metrics
  • Must stop working in silos
  • A real paradigm shift in moving from a production model to a collaborative, integrative type of care system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Assessing health care quality is based on using three components:

A

structure, processes, outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

which health care quality component includes:

  • settings in which care occurs (hospitals, clinics)
  • material resources (facilities, equipment, and money)
  • human resources (personnel)
  • Organizational structure (medical staff organizations, peer review, and revenue cycles)
A

structure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

which healthcare quality component includes:

  • action taken by care teams and staff as they deliver care to patients; and
  • processes which support the needs of the business
A

processes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

which healthcare quality component includes:

  • patient’s experience as a result of the care provided
A

outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Care delivered in the past focused on the ___ as the center of the team

A

medical provider

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Care delivered in the present focuses on the ___ as the central member with all members of the health care team being critical components to optimizing patient health outcomes

A

patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Primary care delivery teams which have include MDs, RNs, LPNs, desk and administrative staff are changing to ___ population health teams

A

“core”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Population health core team has expanded to include ___ as care manager roles, social workers, behavioral/mental health specialist, pharmacists, dieticians, and other health specialist as needed to implement processes of care delivery that allows the member to perform at the maximum of his or her licensure

A

PAs, RNs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Reinforces need for collaboration and discontinuation of the “silo” model of care

A

accountable care and population health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

management and payment for healthcare services for a discrete or defined population

A

population management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

the design, delivery, coordination, and payment of high-quality health care services to manage the Triple Aim using the best resources available

A

Population medicine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Figuring out which group is neediest or at higher risk is required for

A

population management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

registries, data bases, ability to benchmark, supporting Triple Aim (content analytics and deployment), predictive medicine or healthcare

A

information technology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

“The combined and unceasing efforts of everyone – health care professionals, patients and their families, researchers, payers, planners and educators – to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development.”

A

Batalden and Davidoff on continued improvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

To assess the quality of care provided in medical settings

A

Donabedian Model

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Donabedian Model:

facilities, equipment, staffing, qualifications, licensing, accreditation

A

structure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Donabedian Model:

  • technical care (screening, prevention, diagnosis, treatment, follow-up care)
  • interpersonal care (respect, communication, knowledge and information)
A

process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Donabedian Model:

  • acute recovery, restoration of function, survival, efficiency
A

outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q
  • Physician who specializes in inpatient care
  • Stays in hospital majority of time
  • PMDs trying to be in multiple care settings at once
  • Safety considerations – “To Err is human: Building a Safer Medical System.” (Focused on medical errors in the hospital setting.)
A

hospitalist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q
  • NPs, must have minimum Bachelor’s in Nursing and then Master’s program. State and National Boards. Apply for controlled furnishing license through DEA.
  • PAs, program started initially for military medics to become licensed to practice in civilian environment. Currently, must have minimum required number of hours in medical field in some capacity and can apply for program. Master’s prepared.
  • Examine, interpret, diagnose, treat, prescribe
  • Some states have full authority, some don’t
  • Currently, in California MUST have a supervising physician
  • Can work in any setting educated/trained/qualified to provide care
A

Nurse Practitioners and Physician Assistants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q
  • Most are Master’s prepared
  • Transition from one level of care to another – from inpatient to rehab, from rehab to home with home health services, etc.
  • Coordination of medications, supplies, durable medical equipment
  • Insurance negotiators and mediators
  • Placement in shelters, finding housing
  • Domestic violence
  • CPS/APS
A

Care Coordinators and Social Workers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q
  • Usually RN, minimum of Bachelor’s Degree in Nursing
  • Reviews patient record including all H&Ps, diagnoses, progress notes, treatment plans, nursing notes and interventions, outcomes of surgeries and other procedures to ensure insurance requirements met for continued stay
  • Collaborates with care providers and staff
A

Utilization Management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q
  • Education and experience varies
  • Helps patients navigate a chronic or complicated treatment path
  • Communicates with other providers and team-members
  • Ensures plans are patient-centered
  • May help patient advocate for additional services or needs
A

Patient Navigators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q
  • Jointly funded state and federal program
  • Generally serves low income individuals and families
  • Each state chooses own qualifying levels, usually below poverty line
  • ACA attempted to expand services but ultimately, each state still determines qualifications
A

Medi-Cal / Medicaid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q
  • most flexible of plans
  • may be small / large deductible depending on plan
  • co-pays, variable
  • required to see “in-network” providers for the best cost benefit
  • “out of network” provider, costs are paid at a much lower level
  • need prior authorization for some services, but patient can self refer to specialists
A

PPO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q
  • may see only those providers and utilize services within the contracted network
  • monthly premiums are usually less than PPO
  • chosen or assigned PMD manages and coordinates your care
  • patient must go through PMD for referrals to specialists or other
  • limitations but can also be very effective
A

Health Maintenance Organization (HMO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q
  • monies can be placed in a certain type of account for patient use
  • used only for medically related costs (prescription or office co-pays, glasses or contacts, dressing supplies)
  • employers sometimes contribute
  • many rules about these accounts
  • usually comes with a card much like a credit card or debit card patient can use whenever they choose
A

Health Savings Account (HSA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

list of medications that are covered under a particular plan

  • May be tiers
  • Each tier is offered at a different cost point
  • If medication is not on formulary, may attempt an authorization to use
A

Formulary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Health care provider asks permission from insurance company to obtain a CT scan, MRI, schedule a surgical procedure, etc.

A

Prior Authorization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

care is moving from ___ and ___ to ___

A

fee-for-service; volume-based reimbursement;

Value Based Care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

up-to-date services, best practices, evidenced-based care, established best practices

A

effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

duplication of services, wasted equipment, supplies, resources

A

efficient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

5 Domains of Healthcare

A

Knowledge, Care Delivery, Payer Domain, Medical-Legal, Regulatory

Kevin Can Pay My Rent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

the most important perspective is that of the

A

patient!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Current Value of US Healthcare

A
  • Battling rapidly rising costs
  • Uneven access to services
  • Patient outcomes that place the United States at the bottom of the developed world when ranked amongst nations
  • Variable value, quality, and cost.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

a major factor contributing to poor-quality care

A

safety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

service is moving from assessing by ___ to ___

A

“patient satisfaction”;

“patient opinion of care received”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

US spends significantly more ___ and a higher percentage of ___ on healthcare that other countries spend

A

per capita;

gross domestic product

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Majority of healthcare dollars are spent on

A

the sickest patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Little funding goes to ___that have large impact on overall population health

A

prevention, health promotion, addressing lifestyle, environmental, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

one of the largest contributors to US debt

A

cost of care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

___ correlation between cost of care and quality of care

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Many categories of waste, but two that apply directly to provision of care

A

unnecessary services and inefficient care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

“Price is what you pay, ___ is what you get.”

A

value;

by Warren Buffett

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

attributes of high-value healthcare system

A
  1. Clear and shared vision that is patient-centered
  2. Leadership and professionalism from health care providers
  3. Training that emphasizes teamwork, systems engineering, process improvement
  4. IT infrastructure that supports development & maintenance of
    - Learning health care system
    - Information exchange
    - Stringent peer review process
    - Use of best-practice & evidence-based medicine
  5. Insurance for all with patients owning their own insurance and can choose & access appropriate medical care
  6. Reimbursement models without incentives for volume-based care & promote integration & coordination, prevention, & health promotion.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

barriers to high-value care

A
  • conflicting stakeholder incentives (idea that “more care is better care”)
  • lack of share reality
  • poor integration
  • inadequate education healthcare professionals
  • serial nature of health insurance coverage
  • perverse provider reimbursement structures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

“most expensive piece of medical equipment is the physician’s ___”

A

pen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

other developed countries have an insurance plan that is a

A

“cradle to grave” type over coverage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Value-based delivery models have transferred risk away from payers like Medicare to the

A

hospital and surgeon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Ultimately, if the test results will not change the care of the patient, the test should be

A

reconsidered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Reimbursement for care provided is shifting from a system based on ___ to one based on ___

A

volume;

providing value

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

HCV (healthcare value?) is best defined by:

A
  • Quality of care divided by the cost of care over time
  • STEEP
  • Triple Aim
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

US continues to struggle with HVC as evidenced by:

A
  • Variation in patient outcomes
  • Safety
  • Satisfaction
  • Cost of care
  • Poor integration & coordination of services
  • Fragmented and volume-based provider reimbursement
  • Conflicting stakeholder incentives
  • Social determinants of health
  • Micro-inefficiencies (patient-provider interactions)
  • Macro-inefficiencies (health policy and the larger system).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

do your best to

A

provide leadership (Identify opportunities to improve outcomes, Minimize harms, Reduce health care waste)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

divided into experimental and control groups

A

clinical trials

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

group given the treatment under investigation

A

experimental

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

group treated in the exact same way as the experimental group except not given treatment

A

control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

help to eliminate alternative explanations for a study’s results

A

Control groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

patients are randomly assigned to different groups (ie. To the experimental and control groups)

A

Randomization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

to equalize the effects of extraneous variables

A

randomization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Simple descriptive account of interesting characteristics observed in a group of patients

A

case-series

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Observational studies include:

A

Case-Series;
Case-Control;
Cross-Sectional;
Cohort Studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Patients seen over a relatively short time

A

case-series

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Do not include control subjects

A

case-series

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Begin with the absence or presence of an outcome andthen look backward in time to try to detect possiblecauses or risk factors

A

case-control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

case-control studies look ___ in time

A

backward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Individuals selected on the basis of some disease or outcome

A

cases (case-control)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Individuals without the disease or outcome

A

controls (case-control)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Analyze data collected on a group of subjects at one time rather than over a period of time.

A

cross-sectional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Designed to determine what is happening right now.

A

cross-sectional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

group of people who have something in common and who remain part of a group over an extended time.

A

cohort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

looks forward in time

A

cohort studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

cohort studies look ___ in time

A

forward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

frequency of disease and of risk-related factors are assess in the present

A

cross-sectional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

can show risk factor association with disease, can’t establish causality

A

cross-sectional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Compares a group of people with disease to a group without disease

A

case-control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Looks to see if odds of prior exposure or risk factor differs by disease state.

A

case-control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

asks “what is happening?”

A

cross-sectional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

asks “what happened?”

A

case-control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

asks “what will happen?”

A

cohort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

odds ratio

A

case-control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

relative risk

A

cohort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Compares a group with a given exposure or risk factor to a group without such exposure

A

cohort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Looks to see if exposure or risk factor is associated with later development of disease

A

cohort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

can be prospective or retrospective

A

cohort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Compares the frequency with which both monozygotic twins vs both dizygotic twins develop the same disease.

A

twin concordance study

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Measures heritability and influence of environmental factors (“nature vs. Nurture”)

A

twin concordance study

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Compares siblings raised by biological vs adoptive parents.

A

adoption study

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Measures heritability and influence of environmental factors.

A

adoption study

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

have one or more groups of patients which are observed and characteristics about the patients are recorded for analysis

A

observational studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Easier to identify than observational studies in the medical literature.

A

experimental studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Involve an intervention.

A

experimental studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Experimental Studies that involve humans (not animals)

A

clinical trials

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

purpose is to draw conclusions about a particular procedure or treatment

A

clinical trials

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Epitome of all research designs because it provides the strongest evidence for concluding causation.

A

randomized controlled trials (RCT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

It provides the best insurance that the results were due to the intervention.

A

randomized controlled trials (RCT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

clinical trial undergoes 4 phases:

A

I. “safe?”
II. “effective?”
III. “improvement?”
IV. “stay?”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

the gold standard, or reference in medicine

A

randomized controlled trials (RCT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Least number of problems or biases

A

randomized controlled trials (RCT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

best type of study to use when the objective is to establishthe efficacy of a treatment or a procedure.

A

clinical trials

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

are the design of choice for studying the causes of a condition, the course of a disease, or the risk factors because they are longitudinal and follow a group of subjects over a period of time.

A

cohort studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

are appropriate for rare diseases or events, for examining conditions that develop over a long time, and for investigating a preliminary hypothesis

A

case-control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

the quickest and least expensive

A

case-control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

best for determining the status quo of a disease or condition

A

cross-sectional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

easy to write and the observations may be extremely useful to investigators designing a study to evaluate causes or explanations of the observations

A

case-series

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

expensive and time consuming

A

randomized controlled trials (RCT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

the length of time required depends on the problem studied

A

cohort study

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

With diseases that develop over a long period of time or with conditions that occur as a result of long-term exposure to some causative agent, many years are needed and it is very costly

A

cohort study

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

have the largest number of possible biases or errors and they depend on high quality existing records

A

case-control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

provide only a “snapshot in time” of the disease or process, which may result in misleading information

A

cross-sectional

171
Q

common problem with survey research is obtaining sufficiently large response rates

A

cross-sectional

172
Q

conclusions are based on a subset of people who agree to participate, and these people may not be representative of or similar to the entire population.

A

cross-sectional

173
Q

Is the topic of the study important and worth knowing about?

A

abstract

174
Q

What is the purpose of the study?

A

abstract

175
Q

What is the main outcomefrom the study?

A

abstract

176
Q

Is the population of patients relevant to your practice—can you use theseresults in the care of your patients?

A

abstract

177
Q

If statistically significant, dothe results have clinical significance as well?

A

abstract

178
Q

read the abstract to know:

A 
topic of study;
purpose of study;
main outcome;
population (whether results can be generalized);
clinical significance of results
179
Q

What research has already been done on this topic and what outcomeswere reported?

A

introduction

180
Q

read the introduction to know:

A

everything from abstract + previous research / outcomes

181
Q

Is the appropriate study design used?

A

methods

182
Q

Does the study cover an adequateperiod of time? Is the follow up longenough?

A

methods

183
Q

Are the criteria for inclusion and exclusion of subjects clear? How do thesecriteria limit theapplicability of the conclusions?

A

methods

184
Q

Were subjects randomly sampled (or randomly assigned)? Was the samplingmethod adequatelydescribed?

A

methods

185
Q

Are statisticalmethods outlined? Are they appropriate?

A

methods

186
Q

Is there a statement about power—the number of patients that are needed tofind the desiredoutcome?

A

methods

187
Q

read the methods to know:

A 
study design;
period of time;
criteria (whether results can be generalized);
sampling method (randomization?);
sample size
188
Q

Do the reported findings answer the research questions?

A

results

189
Q

Are actual values reported—means, standard deviations, proportions—so that the magnitude of differences can be judged by the reader?

A

results

190
Q

Are groups similar on baseline measures? If not, how did investigatorsdeal with these differences (confounding factors)?

A

results

191
Q

Are the graphs and tables, and there legends, easy to read andunderstand?

A

results

192
Q

If the topic is a diagnostic procedure, is information on both sensitivityand specificity (false-positive rate) given? If predictive values aregiven, is the dependence on prevalence emphasized?

A

results

193
Q

read the results to know:

A

answer to research qs;
actual values;
confounding factors;
graphs/tables

194
Q

Are the research questions adequately discussed?

A

conclusion / discussion

195
Q

Are shortcomings and limitations of the research addressed?

A

conclusion / discussion

196
Q

occurs when a condition is characterized byearly fatalities or silent cases.​

A

prevalence bias

197
Q

can result whenever a time gap occurs betweenexposure and selection of study subjects and the worst cases havedied

A

prevalence bias

198
Q

Occurs when the study admission rates differ, which causes major distortions in risk ratios.

A

admission rate bias

199
Q

This can occur in studies of hospitalized patients when patients who have therisk factor are admitted to the hospital more frequently than either the cases without the risk factor or the controls with the risk factor.

A

admission rate bias

200
Q

When patients either volunteer or refuse to participate in studies.

A

nonresponse bias / volunteer effect

201
Q

Occurs when treatment assignments are made on the basis of certain characteristics of the patients, with the result that the treatment groups are not really similar

A

procedure selection bias

202
Q

Occurs when groups of subjects are not treated in the same manner.

A

procedure bias

203
Q

when the procedures used in an investigation may lead to detection of other problems in patients in the treatment group and make these problems appear to be more prevalent in this group

A

procedure bias

204
Q

when the patients in the treatment group may receive more attention and be followed up more vigorously than those in another group.

A

procedure bias

205
Q

Occurs when patients are asked to recall certain events, and subjects in one group are more likely to remember the events than those in the other group.

A

recall bias

206
Q

people take aspirin commonly and for many reasons, but patients diagnosed as having peptic ulcer disease may recall the ingestion of aspirin with greater accuracy than those without gastrointestinal problems.

A

recall bias

207
Q

solution to recall bias

A

confirmation

208
Q

Can occur because a new diagnostic technique is introduced that is capable of detecting the condition of interest at an earlier stage.

A

detection bias

209
Q

Occurs when patients find it easier or more pleasant to comply with one treatment than with another.

A

compliance bias

210
Q

information is gathered in a manner that distorts the information

A

measurement bias

211
Q

Measuring patient satisfaction with their physicians by using leading questions

A

measurement bias

212
Q

Subjects’ behavior is altered because they are being studied; this is only a factor when there is no control group in a prospective study

A

measurement bias (Hawthorne effect)

213
Q

solution to measurement bias

A

control group

214
Q

The factor being examined is related to other factors of less interest.

A

confounding bias

215
Q

Unanticipated factors obscure a relationship or make it seem like there is one when there is not

A

confounding bias

216
Q

More than one explanation can be found for the presented results

A

confounding bias

217
Q

solution to confounding bias

A

combine the results from multiple studies, meta-analysis

218
Q

Gives a false estimate of survival rates

A

lead-time bias

219
Q

patients seem to live longer with the disease after it is uncovered by a screening test

A

lead-time bias

220
Q

solution to lead-time bias

A

use life-expectancy to assess benefit

221
Q

Severe diseases that tend to be rapidly fatal are less likely to be found by a survey

A

length-time bias

222
Q

Neyman bias or late-look bias

A

length-time bias

223
Q

tend to find (and select for) less aggressive illnesses because patients are more likely to be found by screening.

A

length-time bias

224
Q

solution to length-time bias

A

stratify by severity

225
Q

nonrandom sampling or treatment allocation of subjects such that study population is not representative of target population

A

selection bias

226
Q

most commonly a sampling bias

A

selection bias

227
Q

study population selected from hospital is less healthy than general population

A

Berkson bias (selection bias)

228
Q

participating subjects differ from nonrespondents in meaningful ways

A

non-response bias (selection bias)

229
Q

solution to selection bias

A

randomization; ensure the choice of the right comparison/reference group

230
Q

research’s belief in the efficacy of a treatment changes the outcome of that treatment

A

observer-expectancy bias

231
Q

the study of the distribution and determinants of health-related states within a population

A

epidemiology

232
Q

refers to the patterns of disease and the factors that influence those patterns

A

epidemiology

233
Q

the usual, expected rate of disease over time; the disease is maintained without much variation within a region

A

endemic

234
Q

occurrence of disease in excess of the expected rate; usually presents in a larger geographic span than endemics

A

epidemic

235
Q

study of epidemics

A

epidemiology

236
Q

Worldwide epidemic

A

pandemic

237
Q

visual description (commonly histogram) of disease cases plotted against time

A

epidemic curve

238
Q

classic signature of an epidemic is a

A

“spike” in time

239
Q

actual cases / potential cases =

A

rate

240
Q

promote health, preserve health, restore health when it is impaired, and minimize suffering and distress. These goals aim to minimize both morbidity and mortality

A

goals of prevention in medicine

241
Q

promotes health at both individual and community levels by facilitating health-enhancing behaviors, preventing the onset of risk behaviors, and diminishing exposure to environmental hazards

A

primary prevention

242
Q

decrease disease incidence

A

Primary prevention efforts

243
Q

ex: implementation of exercise programs and healthy food programs in schools.

A

primary prevention

244
Q

screens for risk factors and early detection of asymptomatic or mild disease, permitting timely and effective intervention and curative treatment

A

secondary prevention

245
Q

decrease disease prevalence

A

Secondary prevention efforts

246
Q

ex: recommended annual colonoscopy for patients age > 65 and HIV testing for health care workers with needlestick injuries

A

secondary prevention

247
Q

reduces long-term impairments and disabilities and prevents repeated episodes of clinical illness.

A

tertiary prevention

248
Q

prevent recurrence and slow progression

A

Tertiary prevention efforts

249
Q

ex: physical therapy for spinal injury patients and daily low-dose aspirin for those with previous myocardial infarction

A

tertiary prevention

250
Q

average number of years of life remaining at a given age

A

life expectancy

251
Q

frequency of occurrences of disease, injury, or death—that is, the number of transitions from well to ill, from uninjured to injured, or from alive to dead—in the study population during the time period of the study.

A

incidence

252
Q

looks at new cases (incidents)

A

incidence

253
Q

during a specified time period

A

incidence

254
Q

new cases / #people at risk

A

incidence

255
Q

all persons who experience an event in a population

A

prevalence

256
Q

portion of people in a population who have a particular disease at a specified point in time (or over a specified period of time)

A

prevalence

257
Q

looks at all current cases

A

prevalence

258
Q

at a point in time

A

prevalence

259
Q

existing cases / total #people in a population

A

prevalence

260
Q

prevalence / 1-prevalence =

A

incidence rate x avg duration of disease

261
Q

unusually sensitive to maternal health practices (especially maternal nutrition and use of tobacco, alcohol, and drugs), environmental factors, and the quality of health service

A

health of infants

262
Q

used as an overall index of the health status of a nation.

A

infant mortality rate (IMR)

263
Q

rate with added advantage of being both age specific and available for most countries

A

infant mortality rate

264
Q

deaths to infants / #live births ((at a given place / time period)) x 1000

A

infant mortality rate

265
Q

measure of the progress of a nation in providing adequate nutrition and medical care for pregnant women

A

maternal mortality rate

266
Q

pregnancy-related deaths / #live births ((at a given place/time period)) x 100,000

A

maternal mortality rate

267
Q

deaths due to particular cause / midperiod population x 100,000

A

cause specific death rate

268
Q
  • Greater attention to quality of patient care,
  • Patient safety
  • Rapidly increasing cost of health care.
A

shift from individual care towards population health

269
Q

There is an ___ relationship between health care cost and improved health outcomes

A

inverse

270
Q

focus on both disease management and prevention

A

population health

271
Q

the health outcomes of a group of individuals, including the distribution of health outcomes within the group

A

population health

272
Q

product of multiple determinants of health

A

population health outcomes

273
Q

goes beyond the individual patient focus of traditional medical care and includes the health outcome of groups, communities, or populations of individuals

A

population health

274
Q

define populations within a specific geographic area or communities

A

public health systems

275
Q

define populations within a designated clinical setting or with a particular medical diagnoses

A

physicians and other in the health care setting

276
Q

define their population based on who is need of their services (e.g., support of a medical condition, health care coverage, economic security, housing, transportation, food access or other nonhealthy areas that can greatly impact health and their outcomes).

A

community organizations

277
Q

Population Health has 4 major pillars:

A
  1. Chronic care management
  2. Quality and safety
  3. Public health
  4. Health Policy
278
Q

includes multiple stake holders such as those in health care delivery, the public health system, community organizations, health policy, employers, insurers and those generating evidence through research and other initiatives

A

population health

279
Q

strongly focused on analysis of outcome to drive process change and new policy

A

population health

280
Q

significant driver to influence change in many stakeholder groups as well as across groups

A

health policy

281
Q

multiple factors that influence an individual’s health and the health of the population

A

determinants of population health

282
Q

determinants of population health include:

A 
behavior;
genetics;
social circumstances;
physical and environmental;
healthcare
283
Q

determinant that includes:

smoking, risk taking, exercise, nutrition

A

behavior

284
Q

determinant that includes:

age, biologic sex, inherited health conditions

A

genetics

285
Q

determinant that includes:

income, social support, education

A

social circumstances

286
Q

determinant that includes:

natural environment, green spaces, built environment, housing quality, conditions, exposures

A

physical and environmental

287
Q

determinant that includes:

availability of quality healthcare, access and health insurace

A

healthcare

288
Q

broadly encompass the social circumstances, environmental exposures, and health care determinants of health

A

social determinants of health (SDOH)

289
Q

The social environment, physical environment, and health care services all contribute to the

A

“social patterning of health, disease and illness.”

290
Q

They are recognized as interacting with and influencing behavior and contributing substantially to differences in health outcome between groups of people.

A

social determinants of health (SDOH)

291
Q

5 Key Elements of social determinants of health (SDOH):

A 
economic stability;
education;
social and community context;
health and health care;
neighborhood and built environment
292
Q

social determinant of health that includes:

poverty, food security, employment

A

economic stability

293
Q

social determinant of health that includes:

rate of high school graduation, secondary education, early childhood education and development

A

education

294
Q

social determinant of health that includes:

civic participation and sense of community, perceptions of discrimination and equity, incarceration

A

social and community context

295
Q

social determinant of health that includes:

access to health care and insurance, health literacy, prescription coverage

A

health and healthcare

296
Q

social determinant of health that includes:

access to healthy food and areas to exercise, quality of housing, crime and violence

A

neighborhood and built environment

297
Q

“The iterative process of strategically and proactively managing clinical and financial opportunities to improve health outcomes and patient engagement while reducing costs.”

A

population health management

298
Q

“The iterative process of strategically and proactively managing clinical and financial opportunities to improve health outcomes and patient engagement while reducing costs.”

A

population health management

299
Q

“The design, delivery, coordination, and payment of high-quality health care services to mange the Triple Aim for a population using the best resources we have available within the health care system.”

A

population medicine

300
Q

“What we as a society do collectively to assure the conditions in which people can be healthy.”

A

public health

301
Q

a long-standing discipline focused on the health of entire populations, communities, states, countries, and even regions of the world

A

public health

302
Q

organized through agencies at federal, state, local, and tribally levels.

A

public health

303
Q

include prevention of disease, promotion of health, protection against environmental hazards, disaster preparedness, and assurance of health care quality and accessibility.

A

Important public health fundamentals

304
Q

not focused on individual medical care and private sector health care delivery.

A

public health system

305
Q

3 Core Functions of Public Health:

A
  • assessment
  • policy development
  • assurance
306
Q

extensive and include public, private, and voluntary entities

A

the reach of public health

307
Q

core function of public health that includes:

monitors health status to identify, diagnose, solve, and monitor health problems or hazards in the community.

A

Assessment

308
Q

core function of public health that includes:

informs, educates and mobilizes individuals and community partners to identify and solve health problems by developing and and supporting new and existing policies and plans

A

Policy Development

309
Q

core function of public health that includes:

enforces laws and regulations that protect health; links individuals to health services if needed; and evaluates effectiveness, accessibility, and quality of individual and population health services

A

Assurance

310
Q

ex: national tobacco public health surveillance

A

Federal - Assessment

311
Q

ex: smoking ban on commercial flights

A

Federal - Policy Development

312
Q

ex: grants for antismoking research

A

Federal - Assurance

313
Q

ex: monitor state tobacco use

A

State - Assessment

314
Q

ex: increase tobacco tax

A

State - Policy Development

315
Q

ex: funding for campaign though Prop 99

A

State - Assurance

316
Q

ex: report on local tobacco use

A

Local - Assessment

317
Q

ex: county laws prohibiting smoking in bars

A

Local - Policy Development

318
Q

ex: resources to help smokers quit in multiple languages

A

Local - Assurance

319
Q

partners in the public health system ensuring the conditions for population health include:

A 
community,
clinical care delivery system, 
employers and business nongovernment organizations, 
the media, 
academia, 
government public health infrastructure
320
Q

“A law, regulation, procedure, administrative action, incentive, or voluntary practice of governments and other institutions.”

A

health policy

321
Q

plays an important role in driving change such as in the case of national-level policy producing change on reimbursements and requirements for extensive quality and cost reporting.

A

health policy

322
Q

interventions tend to be at higher organizational levels than the individual or practice

A

public health

323
Q

What we do as a collective society to improve the health of the general population.

  • Monitors community health status
  • Investigates health problems
  • Develops programs and initiatives focused on health
  • Primarily community based
  • Involves public, private and voluntary entities that contribute to delivery of essential public health services within its jurisdiction
  • Connected to government health departments
  • Enforces laws and regulations that protect health
A

public health

324
Q

What we do to improve the health outcomes of a group of individuals.

  • Reaches more broadly into the delivery arena
  • Encompasses disease prevention, health promotion
  • Involves participants in areas of prevention, health care delivery, medical intervention, public health, and policy for a population.
  • Less connected to government health department
  • Includes community engagements and resources
  • “To manage the health of a specific population using a network of financially incented providers and community partners”
A

population health

325
Q
  • A focus on sick care over prevention and wellness. Clinical training has traditionally focused acute illness and chronic disease care over prevention and wellness.
  • The fee-for-service reimbursement system has been more heavily based on acute care and procedures.
  • Prevention, chronic disease management, nutrition, and behavioral health have been traditionally undervalued and reimbursed at rates lass than acute care.
  • There is minimal reimbursement for non-clinic follow-up such as telephone calls used more for surveillance in chronic disease prevention and management.
  • Preventative services for patients are generally more difficult to receive than acute care.
  • In addition, the public health sector with its focus on prevention and health promotion has been relatively underfunded as compared to acute care reimbursement.
A

limitations in US healthcare that need to be overcome to achieve improved population health

326
Q
  • Health care delivery is often organized and prioritized around health care delivery than the patient.
  • Patients typically must initiate contact and access many different points in order to receive care.
  • Lack of coordination, integration and communication between the different points of a patient’s care contribute to fragmentation of the health care system.
  • In addition, connections between medical care, public health, and community resources for patients to support their health and health care have been limited.
A

Siloed and fragmented efforts for health and health care

327
Q
  • Communication and sharing information between the various parties involved in the care of the patient is often limited.
  • Barriers to greater communication and coordination of care include limitations in electronic health records limitation in health information exchange.
A

Inadequate assimilation and use of data

328
Q
  • Lack of defined teams for patient care, lack of tools, and time constraints on an individual physician impact the ability for greater engagement of patients in their health care.
  • Patient-centeredness and shared decision making have not typically been robust areas of clinical training.
  • Patient education resources and tools are often inadequate and most care delivery via an in-clinic setting may not be feasible for patients to take time away from work, school, family or other obligations.
A

Suboptimal patient engagement

329
Q
  • Where people live, their socioeconomic status, their race, ethnicity, gender, age, sexual orientation, and disability status have historically impacted health and outcomes.
  • Comprehensive solutions that address the impact of SDOH and health outcomes have been difficult to develop.
  • Root causes are often complex, and policy, funding, and support targeted at these areas have not been robust.
A

Inequality and inequity in health and health outcomes

330
Q
  • A fee-for-service reimbursement system often reinforces fragmented efforts as individual physicians are paid separately for their part of the patient’s care.
  • In many systems, physicians are not held accountable and often not reimbursed for the quality of care provided for care coordination in a traditional fee-for-service system.
  • Incentives are misaligned in health care as care and procedures are reimbursed at a greater rate then preventative care.
A

Reimbursement systems, incentives, education, and culture that support the status quo

331
Q

the US still lags in key outcomes measures, including

A

life expectancy and prevalence of chronic disease.

332
Q

necessitates coordinated care along with the use and exchange of data and patient engagement.

A

optimal disease management

333
Q

“a particular type of health difference that is closely linked with social, economic, and or environmental disadvantage.”

A

health disparity

334
Q

adversely affect groups of people who have systematically experienced greater obstacles to health based on their ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, or physical disability, sexual orientation, gender identity, geographic location or other characteristics of discrimination or exclusion.

A

health disparities

335
Q

provided comprehensive, team-based, patient centered, coordinated accessible care focused on quality and patient safety

A

The Primary Care Medical Home (PCMH) model of primary care

336
Q

an entity in formal agreement with a payer to care for a population of patients is accountable for quality, cost, and outcomes for its patient population.

A

Accountable Care Organizations (ACOs)

337
Q

have the capability to share information with other health care providers and medical professionals. Patient’s information (diagnosis, prescribed medication) and data values (labs) allow for data to be analyzed on how well clinicians are managing both acute and chronic disease processes for individual patients and populations of patients.

A

Electronic Health Records (EHRs)

338
Q

not all EHR systems communicate with each other thereby limiting relaying data or receiving data outside the population being served by the EHR.

Often HER may not provide data on social determinants of health and therefore this limited opportunity to obtain the whole picture of the patient population’s health status beyond the medical care.

A

limitations of EHRs

339
Q
  1. Integrate data from multiple health sources across the continuum of care (EHRs) and other sources such as mobile applications, wearable technology and other data sources with which a patient may interact.
  2. Develop then integrate clinical risk algorithms into the care of the patients and populations to ensure that those who need treatment receive and while others who do not treatment are not overtreated.
  3. Deliver the analysis of the data to those who must act on it such ad health care administrators who allocate resources based on the populations need. Clinicians who receive the data to improve clinical care of the patient populations, and individuals who can advocate for their own health care needs.
A

Risk Stratification and Analytic Software

340
Q

are secure websites that can interface with an EHR and serves as a 24/7 access point for patients

can provide two-way communication between patients and practices which includes many members of the health team.

A

Patient Portals

341
Q
  • Summaries of recent physician visits
  • Hospital discharge summaries
  • Medications
  • Immunizations
  • Allergies
  • Laboratory results
A

can be accessed through patient portals

342
Q

mobile electronic devices that can be unobtrusively embedded in the user’s outfit as part of the clothing or accessory.

A

Wearable Devices and Biosensors

343
Q

allows for monitoring of factors influencing an individual’s health, including monitoring of vital signs or number of steps taken in which the information taken can be integrated with other health care data to more effectively manage the health of the population.

A

Wearable technology

344
Q

is the use of medical information that is exchanged from one site to another through electronic communications.” There are varying types of processes and services intended to enrich the delivery medical care and improve the health status of patients.

A

Virtual Health

345
Q

coordinate and organize clinical care around individual patients as well as populations of patients.

serve as the bridge between patients and their physicians and health care professionals.

  • Act as a conduit between patient and physician
  • Answer patient questions
  • Assist in managing chronic medical conditions
  • Facilitate the transfer of information among a patient’s providers, including specialty physicians
  • Conduct home or hospital visits
A

Nurse Care Managers

346
Q

defined as “frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served.”

role is adapted to the needs of the community they serve.

role is expanding to integrate hospital and clinic health care teams with a greater focus on chronic disease management.

A

Community Health Workers (CHW)

347
Q

defined as “a member of the health care team who helps patients ‘navigate’ the health care system and get timely care.”

  • Help coordinate patient care
  • Connect patients with resources
  • Help patients understand the health care system
  • Often found in physician’s offices to help patient navigate through one or more chronic health condition
A

Patient Navigators

348
Q

Their work includes:

  • Initial consults
  • Ongoing management
  • Medication management
A

Integrated Behavioral Health Specialist – behavioral health specialist (psychiatrists, psychologist, social workers, and other mental health works)

349
Q

“process that uses quantitative and qualitative methods to systematically collect and analyze data to understand health within a specific community”.

A

“community health needs assessment” (CHNA)

350
Q

Structural Determinants of Health Inequities include:

A

class, gender, race / ethnicity, education

351
Q

Social Determinants of Health include:

A 
Material Circumstances;
Socio-environmental Circumstances;
Psychosocial Intermidiaries;
Behavioral / Biologic Factors;
Health System
352
Q

social determinant of health that includes:

  • neighborhood and built environment
  • food environment
A

material circumstances

353
Q

social determinant of health that includes:

  • early childhood development and adverse childhood experiences
  • populations subject to societal discrimination
A

socio-environmental circumstances

354
Q

social determinant of health that includes:

  • health literacy
  • physician workforce
A

health system

355
Q

“higher ___ are associated with poorer health outcomes in both general and clinical populations”

A

allostatic load (accumulated stress) and overload

356
Q

How Structural and Social Determinants Lead to Adverse Health Outcome

A
  • allostatic load
  • negative impacts in neuroanatomy and neuroplasticity
  • immune dysregulation
  • epigenetic changes
357
Q

Often measured as a combination of education, income, and occupation

A

class

358
Q

Fresno has a ___ portion of middle income households and ___ portion of lower income households than the United State

A

smaller;

larger

359
Q

Significant health disparities by race and ethnicity, even when controlling for socioeconomic status are mostly about

A

structural racism (housing policies, criminal justice, educational funds)

360
Q

County demographics vary by

A

geographic location

361
Q

___ is biological; ___ is a social construct

A

sex;

gender

362
Q

A person’s zip code is a better predictor of health outcomes than [their] genetic code.”

A

material circumstances

363
Q

three key considerations for material circumstances include:

A
  1. physical conditions within homes (mold, lead)
  2. conditions in the neighborhoods surrounding the homes
  3. housing affordability
364
Q

Policies and practices from 1880s onward are still ___ impacting the health of Fresnans.

A

negatively

365
Q

Neighborhood and built environment was the ___ highest SDOH priority by focus group participants, both rural and urban

A

third

366
Q

89% of those living in the 20 most polluted Census tracts of Fresno County are people of

A

color

367
Q

About ___ of households in Fresno County cannot afford to rent housing

A

25%

368
Q

The number of people experiencing homelessness in Fresno City rose by ___ in Fresno City and by ___ in Fresno County from 2019 to 2020

A

69%;

15%

369
Q

the strongest predictors of homelessnes

A

Availability of low-income housing and mental health care

370
Q

Unhoused persons have shorter life expectancy by ___ than their housed peers, most commonly due to ___

A

30 years;

preventable and treatable chronic medical conditions

371
Q

Food security for a household means access by ___ for an active, healthy life

A

all members at all times to enough food

372
Q

food security at a minimum includes:

A
  1. Availability
  2. Access
  3. Utilization
373
Q

food security measured on a continuum:

A

high – marginal – low – very low

374
Q

In 2019, Fresno County had ___ rates of overall food insecurity than California and the U.S.

A

greater

375
Q

Fresno County has the ___ highest rate in CA of food stamp recipients as a percentage of all households

A

fourth

376
Q

Fresno County has the ___ highest rate in the United States of food stamp recipients as a percentage of all households.

A

seventh

377
Q

3 Main Adverse Childhood Experiences (ACEs):

A

Abuse;
Household Challenges;
Neglect

378
Q
  • emotional
  • physical
  • sexual
A

abuse

379
Q
  • mother treated violently
  • substance abuse
  • mental illness
  • parental separation / divorce
  • incarcerated household member
A

household challenges

380
Q
  • emotional

- physical

A

neglect

381
Q

3 most reported ACEs:

A
  1. emotionally abused
  2. lived with someone who abused substance
  3. parents separated / divorced
382
Q

ACEs negatively impact health and well-being from

A

conception to death

383
Q

is any condition of the body or mind (impairment) that makes it more difficult for the person with the condition to do certain activities (activity limitation) and interact with the world around them (participation restrictions)

A

disability

384
Q

the direct and indirect costs of caring for a family member with a disability can lead to financial difficulties or loss of socioeconomic status

A

intersectionality

385
Q

The rate of Fresno County adults reporting a disability is ___ than the state and national rate

A

higher

386
Q

“health conditions involving changes in emotion, thinking or behavior (or a combination of these”

A

mental illness

387
Q

When writing patient education materials or surveys, aim for a ___ grade reading level

A

6th

388
Q

avoid chairman, chairwoman

A

prefer chair, chairperson

389
Q

avoid mothering

A

prefer parenting, nurturing, caregiving

390
Q

avoid transgender

A

prefer transgender person

391
Q

“describe one of several very broad categories that people are divided into that are biologically arbitrary yet considered to be generally based on ancestral origin and shared physical characteristics”

A

race

392
Q

“a person’s cultural identity, which may or may not include a shared language, shared customs, shared religious expression, or a shared nationality”

A

ethnicity

393
Q

avoid indian, black, asian

A

prefer Native American / American Indian, Black / African American, Asian American

394
Q

avoid seniors, elderly, the aged, aging dependents, old-old, young-old

A

prefer older person, older people, older adults, older patients, older individuals, persons 65 years and older, the older population

395
Q

avoid the poor, the homeless / vagrant

A

prefer no income / low income / limited income / resource limited / resource poor, homeless people / people without housing / unhoused person / houseless person / person experiencing homelessness

396
Q

avoid wheelchair bound, the blind / visually impaired, retarded adult, disabled child

A

prefer wheelchair user, blind people / persons with visual impairment, adult with an intellectual disability, child with a physical disability

397
Q

avoid alcoholic, schizophrenic, noncompliant

A

prefer person with alcohol use disorder, person with schizophrenia, unable to adhere

398
Q

In the past, medical leadership was based on:

A
  • Clinical skills
  • Scholarly product
  • Research excellence
399
Q

Present day health leadership requires not only current clinical knowledge but also:

A
  • Creative thinking
  • Ability to work across multiple disciplines
  • Engage, motivate, and problem-solve in team
  • Utilize operational skills
  • Understand the culture of the organizational
400
Q

4 Mental Models for health care leaders:

A
  1. Individuals and their families as partners in care
  2. Focus on value (quality per cost)
  3. Service alignment with payment systems
  4. Empowerment of all participants as improvers
401
Q

Influential Leadership Theories include:

A
  • Transformational (how leaders transcend own self-interest for higher-order goals and visions)
  • Situational
  • Servant
402
Q

Transformational theory includes:

A
  • Idealized influence
  • Inspirational motivation
  • Intellectual stimulation
  • Individualized consideration
403
Q

Situational theory includes:

A

directing, coaching, supporting, delegating

404
Q

Servant theory includes:

A

listening, empathizing, accepting stewardship, actively developing others’ potential

405
Q

6 Domains of Health Care Leadership Competencies include:

A
  1. Health Care Foundations (patient-centeredness, professionalism)
  2. Self-Management (emotional intelligence, pursuing excellence)
  3. Team Management (relationship management, human resources)
  4. Influence and Communication (advocacy, having challenging conversations)
  5. Systems-Based Practice / Management (business knowledge and skills)
  6. Executing Toward a Vision (creating culture and sustainable solutions)
406
Q

two or more individuals brought together by an organization who are interactively working on one or more institutional goals/tasks and are assigned different roles and responsibilities…with linkages to the broader system or task environment

A

teams

407
Q

cooperative or coordinated effort on the part of a group of persons acting together as a team

A

teamwork

408
Q

an understanding of teams, their structures, and critical elements

A

team science

409
Q

physicians and health care professionals from other disciplines and specialties work together with patients, families, caregivers, and communities to deliver high quality care

A

interprofessional practice

410
Q

organizations that operate in complex, hazardous environment’s making few mistakes over long periods of time; focus on teams.

A

High-reliability Organizations (HROs)

411
Q

characteristics of an effective team include:

A

achieve the goals;
clearly define each member’s role and outline expectations;
team cohesion and low levels of conflict

412
Q

Selecting which members to include on a team depends on the

A

possible member’s knowledge, skill set, and attitudes to accomplish the defined goal

413
Q

4 Stages of Team Development (Bruce Tuckman’s Model of Development)

A
  1. Forming
  2. Storming
  3. Norming
  4. Performing
414
Q

the stage of exploration and building trust; team members are identified, group goals are set, and team members begin to understand the capabilities of other members

A

Stage 1 - Forming

415
Q

attitude changes, competitiveness and tension, disunity; roles and responsibilities are delineated and patterns of communication are established. This can be a difficult phase if tension and disunity develop. Strong leadership is essential to ensure transparency and open communication

A

Stage 2 - Storming

416
Q

satisfaction, respect development, decision-making; trust is established, members can rely on one another, and disagree respectfully as the team aims towards achieving their goals

A

Stage 3 - Norming

417
Q

high level of interaction, performance increased and optimize, and confidence within the team; the common goal has been established, trust is the norm, and productive work is performed with efficiency

A

Stage 4 - Performing

418
Q

4 Interprofessional Domains include:

A
  1. Values / Ethics for Interprofessional Practice (mutual respect and shared values)
  2. Roles / Responsibilities (shared acknowledgement)
  3. Interprofessional Communication (responsible manner that supports approaches)
  4. Teams and Teamwork (relationship-building values and principles of team dynamics)
419
Q
  • Intention to honor another individual’s beliefs, customs, values
  • Self-willingness to explore, examine, critique own beliefs and values
  • Open to learning from other
A

cultural humility

420
Q
  • Understandings that are taught, trained, or achieved
  • necessary for working effectively with diverse patients
  • The more knowledge an individual has regarding another culture, potentially, the more competent they are considered
A

cultural competence

421
Q

doesn’t rely on acquisition of formal knowledge relative to another culture, rather it focuses on interpersonal sensitivity, openness, avoidance of stereotyping, equalizing power inequities

A

humility

422
Q 
consists of criteria or components:
–Cultural awareness
–Knowledge 
–Skill
–Desire
–Encounter
A

competence

423
Q
  • Synergistic process between the two
  • Allows meaningful connection with others as an individuals
  • Diverse perspective, cultures, lifestyles
  • Awareness of our own biases and viewpoints
A

competemility

PRHS I - OMS I (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions