Public health Flashcards
Disease prevention - primary
Prevent disease occurrence
Disease prevention - secondary
Screening early for disease
Disease prevention - tertiary
Treatment to reduce disability from disease
Disease prevention - quaternary
Identifying patients at risk of unnecessary treatment, protecting from the harm of new intervention
Disease prevention - chemotherapy
Tertiary Disease prevention
Disease prevention - HPV vaccination
Primary Disease prevention
Disease prevention - pap smear
Disease prevention Secondary
Medicare and Medicaid
Federal programs that originated from amendments to the Social Security Act
Medicaid is joint ….
Federal and state health assistance for people with very low income (indigent)
Medicaid - coverage
inpatient and outpatient hospital care physician service home health care Prescription drugs Long term nursing home care dental care, eyeglasses, hearing aids laboratory test and dialysis No co-payment or deductible
Medicare is divided to
part A, B, C, D
Medicare is available to
patients: 1. >= 65 years old 2. patients with certain disabilities 3. End stage renal disease
Medicare part A coverage
inpatient hospital costs
home health care
hospice care
Medicare part B coverage
physician fees, dialysis, physical therpay, lab tests, ambulance services, medical equipment
Medicare part C coverage
part A and B delivered by approved private companies
Medicare part d coverage
Prescription drugs
usa - common cause of death in order - under 1
- congenital malformations
- preterm birth
- SIDS
usa - common cause of death in order - 1-14
- Unintentional injury
- cancer
- congenital malformation
usa - common cause of death in order - 15-34
- Unintentional injury
- suicide
- homicide
usa - common cause of death in order - 35-44
- Unintentional injury
- cancer
- Heart disease
usa - common cause of death in order - 45-64
- cancer
- heart disease
- Unintentional injury
usa - common cause of death in order - 64+
- Heart disease
- cancer
- chronic respiratory disease
Hospitalized conditions with frequent readmissions - medicate
- Congestive HF
- Septicemia
- Pneumonia
Hospitalized conditions with frequent readmissions - medicaid
- Mood disorder
- Schizophrenia/psychotic disorder
- DM with complications
Hospitalized conditions with frequent readmissions - private insurance
- maintenance of chemotherapy or radiation
- mood disorder
- complications of surgical procedures or medical care
Hospitalized conditions with frequent readmissions - uninsured
- Mood disorders
- Alcohol related disorders
- Diabetes mellitus with complications
Readmission means
readmission for any reason within 30 days of original admission
Safety culture - definition/purpose
organizational environment in which everyone can freely bring up safety concerns without fear of censure. –> Facilitates errors identifications
event reporting systems collect data on errors for internal and external monitoring
PDSA cycle?
Process improvement model to test changes in real clinical setting. Impact on patients:
Plan - define problem and solution
DO - test new process
Study - measure and analyze data
Act - integrate new process into regular workflow
Swiss cheese model - definition
In complex organizations, flaws in multiple process and systems may align to cause patient harm. Focuses on systems and conditions rather than an individuals error
Swiss cheese model - sequence
Organizational factors –> unsafe supervision –> preconditions –> unsafe acts –> HARM
Types of medical errors may involve
- patient identification
- diagnosis
- monitoring
- nosocomial infections
- medications
- procedures
- devises
- documentation
- handoffs
medical errors are divided to
- active error
2. latent error
active medical error
occurs at level of frontline operator (eg. wrong IV pump dose programmed) –> immediate impact
latent medical error
occurs in process indirect from operator but impacts patient care (eg. different type of IV pumps used within same hospital) –> accident waiting to happen
Medical error analysis are divided to
- Root cause analysis
2. failure mode and effect analysis
Medical error analysis - Root cause analysis - definition
Uses records and participant interviews to identify all the underlying problems that led to an error –> categories of causes include process, people (providers or patients), environment, equipment, materials, management
Medical error analysis - Root cause analysis - characteristics
- Retrospective approach applied after failure event to prevent recurrence
- plotted on fishbone (Ishikawa, cause-and-effect) diagram. Fix causes with corrective action plan
Medical error analysis - failure mode and effect analysis - definition
Uses inductive reasoning to identify all the ways a process might fail and prioritize these by their probability of occurrence and impact on patients
Medical error analysis - failure mode and effect analysis - characteristics
Forward-looking approach applied before implementation to prevent failure occurrence
Quality measurements - appearance
Plotted on run and controls charts
Quality measurements - outcome - measures and example
impact on patients (eg. average HbA1c of patients with diabetes)
Quality measurements - Process - measure and example
performance of system as planned (eg. ratio of patients whose HbA1c was measured the past 6 months)
Quality measurements - Balancing - measure and example
impact on other systems/outcomes (eg. Incidence of hypoglycemia among those patients
if poor and over 65 - medicare vs medicaid
madicare is first use, then medicaid
deductible
the amount the patient must pay out of pocket before the insurance company begins cover expenses
co-payment
typically 20% of the total bill that the patient must pay
medicaid not cover
routine physicals, eye, ears examinations for glasses and hearing aids, immunizations, rootine foot care, most self administrated drugs
medicare vs medicaid according to deductible
medicare –> applicable
medicaid –> not
medicare vs medicaid according to co-payment
medicare –> applicable
medicaid –> not
LONG TERM CARE - Nursing homes and related facilities are classified and priced according to the level of care that they offer -divisions and definitions
- assisted living –> limited care, for example meals and houskeeping and typically (36000/year)
- skilled nursing home –> proferssional nursing care (at least 75000/year)
medicare vs medicaid according to federal and states
both federal
medicaid –> federal AND STATES
health care expenditures in usa have increased because of the
increasing age of the population ,advance in medical technology and availability of health care to the poor and elderly through Medicaid and Medicare, respectively
