Public Health

Question 1

Secondary Disease Prevention

Answer 1

Screen early for and manage existing but asymptomatic disease
E.g. Pap smear for cervical cancer

Question 2

Tertiary Disease Prevention

Answer 2

Treatment to reduce complications from disease that is ongoing or has long-term effects
E.g. Chemotherapy

Question 3

Quarternary Disease Prevention

Answer 3

Identifying patients at risk of unnecessary treatment, protecting from the harm of new interventions

Question 4

Medicare

Answer 4

Federal program that originated from amendments to the Social Security Act
Available to pts over 65 years old, and less than 65 with certain disabilities, and those with end-stage renal disease
4 Parts
Part A: Hospital insurance
Part B: Basic medical bills
Part C: parts A&B delivered by approved private companies
Part D: prescription drugs

Question 5

Medicaid

Answer 5

Federal program that originated from amendments to the social security act
Joint federal and state health assistance for people with very low income (Destitute)

Question 6

Causes of death

Answer 6

1. Congenital malformation
2. Preterm birth
3. SIDS

Question 7

Common Cause of death 1-14 years old

Answer 7

1. Unintentional injury
2. Cancer
3. Congenital malformations

Question 8

Common cause of death 15-34 years old

Answer 8

1. Unintentional injury
2. Suicide
3. Homicide

Question 9

Common Cause of death 35-44 years old

Answer 9

1. Unintentional injury
2. Cancer
3. Heart Disease

Question 10

Common causes of death 45-64 years old

Answer 10

1. Cancer
2. Heart disease
3. Unintentional injury

Question 11

Common cause of death 65+

Answer 11

1. Heart Disease
2. Cancer
3. Chronic respiratory disease

Question 12

Hospitalized conditions with frequent readmissions: Medicare

Answer 12

1. CHF
2. Septicemia
3. Pneumonia

Question 13

Hospitalized conditions with frequent readmissions: Medicaid

Answer 13

1. Mood disorders
2. Schizophrenia/psychotic disorders
3. DM with complications

Question 14

Hospitalized conditions with frequent readmissions: Private insurance

Answer 14

1. Maintenance of chemotherapy or radiotherapy
2. Mood disorders
3. Complications of surgical procedures or medical care

Question 15

Hospitalized conditions with frequent readmissions: Uninsured

Answer 15

1. Mood disorders
2. Alcohol-related disorders
3. DM with complications

Question 16

Safety culture

Answer 16

Organizational environment in which everyone can freely bring up safety concerns without fear of censure (facilitates error identification)
Event reporting systems collect data on errors for internal and external monitoring

Question 17

Human Factors Design

Answer 17

Forcing functions (those that prevent undesirable actions) are the most effective
Standardization improves process reliability (e.g. Clinical pathways, guidelines, checklists)
Simplification reduces wasteful activities (e.g. Consolidating EMRs)

Question 18

PDSA cycle

Answer 18

Process improvement model to test changes in real clinical setting
Plan: define problem and solution
Do: test new process
Study: measure and analyze data
Act: integrate new process into regular workflow

Question 19

Quality measurements: Outcomes

Answer 19

Impact on patients

E.g. Average HbA1C of patients with diabetes

Question 20

Quality measurements: Process

Answer 20

Performance of system as planned

E.g. Ratio of pts whose HbA1C was measured in last 6 months

Question 21

Quality measurements: Balancing

Answer 21

Impact on other systems/outcomes

E.g. Indicence of hypoglycemia among those pts

Question 22

Swiss Cheese Model

Answer 22

In complex organizations, flaws in multiple processes and systems may align to cause pt harm
Focuses on systems and conditions rather than individual’s error

Question 23

Active Error

Answer 23

Occurs at level of frontline operator
E.g. Wrong IV pump dose programmed
Immediate impact

Question 24

Latent Error

Answer 24

Occurs in processes indirect from operator but impacts pt care
E.g. Different types of IV pumps used within the same hospital
Accident waiting to happen

Question 25

Medical error analysis: Root cause analysis

Answer 25

Uses records and participant interviews to identify all the underlying problems that led to an error
Categories of causes include process, people (providers and pts), environment, equipment, materials, management
Retrospective approach applied after failure event to prevent recurrence

Question 26

Medical error analysis: Failure mode and effects analysis

Answer 26

Uses inductive reasoning to identify all the ways a process might fail and prioritize these by their probability of occurrence and impact on pts
Forward-looking approach applied before process implementation to prevent failure occurrence

Question 27

Primary Disease Prevention

Answer 27

Prevent disease before it occurs

E.g. HPV vaccination