Principles and Philosophy Flashcards
3 goals of Evidence Infromed Practice
the best care
based on the best available evidence
for the good of the patient
4 Pillars of EIP
- critical mass of high quality - research evidence trumps authority or experience
- Clinical research can help predict the probability of a particular clinical outcome and the average response
- research focused on patient centered outcomes trumps bench science or research on biological changes in patience
- research evidence must be interpreted thru the lens of experience and integrated with patient preference
5 A’s of EIP
Ask Acquire/Access Appraise Apply Self Asses
Hippocrates
4th centruy BC father of medicine separted religion from medicine believed medicine was a calling and treated all people equal not to differentiate by class or riches
Galen
1st to document details of his surgeries and treatments
forwarded the humours theory of hippocrates (black bile, yellow bile, blood and phlegm)
Dark ages of Medicine
same time as the fall of the Roman Empire
- self treatment was advocated with books explaining process
- religion began to return to healing as the driving force resulting in exhaltation of saints and Miracle Healers
St Rouche
plague
St Dymphna
mental illness
Phillip von Hohenheim
father of modern toxicology
Andreas Versalius
1st to significantly counter and disagree with Galens treatises
authored the Fabric of the Human Body…first major anatomy textbook
The Barber Pole
red is blood (letting) white is bandages, and the blue is for veins
William Hervey
accurately described blood flow and the hearts role
brought an end to the 4 humours theory in the 1600’s
Jenner
created small pox vaccine from cow pox, this was the 1st vaccine
William Thomas Green Morton
first to use Ester as an anesthetic
Anestetics
credited with making surgery a survivable experience
heralded the age of surgery as a modern concept
James Lind
nutritional cures (Vitamin C for scurvy)
Rene Laennec
created the stethescope
Robert Koch
discovered anthrax and Tuberculosis microorganisms
Koch’s postulate
Kochs Postulate
- the causative agent must be present in every case of the disease and must not be present in healthy animals
- the pathagen must be isolated from the diseased host animal and must be grown in pure culture
- the same disease must be produced when microbes from the pure culture are inoculated into healthy, susceptible animals
- the same pathagen must be recoverable once again from this artificially infected animal and must be able to be grown in pure culture
Louis Pasteur
began to articulate the germ theory
Wilhelm Conrad Roentgen
used Crooke’s tube to create the 1st x ray
Gerhard Domagk
inventor of sulfa drugs, the first anitbiotics
followed shortly after was the discovery of pnnicillin
Health Insurrance
financing relies on resource pooling
-process of collecting small amounts of money from many to redisribute those resources to the sick populations to cover costs of their illnesses
“The Bet” of health insurrance (8)
individuals gett ill at a reasonably predictable rate
the ilnneses populations suffer can be reasonably predicted
rational customers do not want to get sick
resultant expenses can be predicted
cost administering can be predicted
the profit of the system can be estimated
the revenue needed to offset the cost, related to the support structure can be prosectively calculated
revenue from all can be pooled to cover costs of the few
Cost of Health Care
$2,809 Billion per year
$8,952 per capita
17.9% of GDP
The percentage of US population not insured at all
15.4%
Reasons for not being insured
Cost of insurance and recently loosing employment
Year of first group health insurance plan
1847
Year of Incorperation of Blue Cross and Blue Shield
1932
Unions in the 40s and 50s
to drive employment increase unions used health insurance as “fringe benefits”
Major Governemtn insurance Plans
Medicare
Medicaid
Tricare
Veterans Administration
Primary Elements of Health Care Financing
Cost
Quality
Access
Cost (managed care)
compensation lower; all products and technologies purchased at substantial discount due to volume and purchase power
Quality (managed care)
standardized practices using evidence and procedural requirements augmented with substantial peer and case oversight, review and control
Access (managed care)
patients and physicians practice in pre-established locations and facilities that have control over technology, equipment and theraputic options
Types of Managed Care Structures
Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Point-of-Service Organization (POS)
Consequences of Managed Care
Patient autonomy is reduced- care is provided through a pre-chosen network or organization
Physician Autonomy is reduced - strict case management, centralized review of the appropriateness of provider practices
Selective Contracting - payers negotiate prices and contract selectively with local providers
Patients experience “Gatekeepers” - must see primary physician who need to prescribe any specialty services
Provider compensation is controlled and often reduced
Potential Problems of Managed Care
Dumping
Creaming
Skimping
Lower Quality
Medicare
established in 1965
to ensure that insurance was available to retired folks
