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public health 3a > public health > Flashcards

public health Flashcards

1
Q

What framework is used to measure quality of care in health service evaluation?

A

Donabedian’s evaluation framework

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2
Q

What three things are involved in Donabedian’s evaluation framework?

A
  • structure
  • process
  • outcome
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3
Q

In the Donabedian’s EF what are the 5D’s to classify outcome?

A
  • Death
  • Disease
  • Disability
  • Discomfort
  • Dissatisfaction
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4
Q

Issues with health outcomes? (5)

A
  • link hard to establish as other factors involved
  • long timelag between service provided and outcome
  • Not large enough sample sizes for statistically signif events
  • data not available
  • issues with data quality
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5
Q

What is a conceptual framework for quality of care?

A

Maxwell’s dimensions of quality

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6
Q

What are maxwell’s 6 dimensions of quality?

A

3Es and 3As

  • Effectiveness
  • Efficiency
  • Equity
  • Acceptability
  • Accessibility
  • Appropriateness
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7
Q

What are some qualitative evaluation methods?

A

Observation, focus groups, interviews, review of documents (relevant stakeholders are consulted as appropriate)

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8
Q

What are some quantitative evaluation methods?

A

Routinely collecting data, review of records, surveys, studies ie epidemiological studies

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9
Q

In the health needs assessment, define need

A

The ability to benefit from an intervention

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10
Q

In the health needs assessment, define demand

A

What people ask for

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11
Q

In the health needs assessment, define supply

A

What is provided

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12
Q

What is health needs assessment?

A

A systematic method for reviewing the health issue facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities

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13
Q

Health need vs health care need

A

Need for health: concerns need in more general terms, measured using mortality, morbidity, socio-demographic measures

Need for healthcare: specific, ability to benefit from HC, depends on potential prevention, tx, care services to remedy health problems

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14
Q

What 4 things comprises Bradshaw’s sociological perspective?

A

Felt need
Expressed need
Normative need
Comparative need

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15
Q

What is felt need?

A

Individual perception of variation from normal health

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16
Q

What is expressed need?

A

Individual seeks help to overcome variation in normal health (demand)

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17
Q

What is normative need?

A

Professional defines intervention appropriate for the expressed need

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18
Q

What is comparative need?

A

Comparison between severity, range of interventions, and cost

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19
Q

What are the three approaches to assessing health needs?

A

epidemiological
comparative
corporate

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20
Q

What is the epidemiological approach to assessing health needs?

A 
Size of the problem
services available 
evidence base
models of care including quality and outcomes measured
existing services 
recommendations
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21
Q

What are the problems with the epidemiological approach to AHN?

A

Data may not be available
Variable data quality
Evidence base may be inadequate
Does not consider felt needs of people affected

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22
Q

What is the comparative approach to assessing health needs?

A

Compares the services received by a population/subgroup with others
Subgroups may be divided by postcode/age/gender/SES/ethnicity

May examine health status, service provision, service utilisation, health outcomes

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23
Q

Issues with the comparative approach to AHN?

A

May not yield what most appropriate level of provision is
Data may not be available
Data may be of variable quality
May be difficult to find a comparable population

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24
Q

What is the corporate approach to assessing health needs?

A

About obtaining the views of a range of stakeholders (asking the population what their health needs are)

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25
Q

What are the issues with corporate approach to AHN?

A

May be difficult to distinguish need from demand
Groups may have vested interests
May be influenced by political agendas
Dominant personalities may have undue influence

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26
Q

Which report described 4 determinants of health?

A

Lalonde report 1974

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27
Q

What are Lalonde’s 4 determinants of health?

A

Genes
Environment
Lifestyle
Healthcare

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28
Q

What is Equity

A

what is fair and just

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29
Q

What is equality?

A

equal shares

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30
Q

What is horizontal equity?

A

Equal treatment for equal need ie all pts with pneumonia treated equally

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31
Q

What is vertical equity?

A

Unequal tx for unequal need
e.g. areas with poorer health may need higher expenditure on health services or people with cold vs pneumonia don’t get same tx

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32
Q

How is health equity examined?

A 
Supply of healthcare
Access to healthcare
Utilisation of healthcare
Healthcare outcomes
Health status

Also: resource allocation and wider determinants of health

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33
Q

What are the three domains of public health practice?

A

Health improvement
Health protection
Health care

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34
Q

Public health domains: What is health improvement?

A

Concerned with societal interventions (not primarily delivered through health services) aimed at preventing disease, promoting health, and reducing inequalities

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35
Q

Public health domains: What is health protection?

A

Concerned with measures to control infectious disease risks and environmental hazards

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36
Q

Public health domains: What is health care?

A

Concerned with the organisation and delivery of safe, high quality services for prevention, treatment and care

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37
Q

Examples of health improvement

A 
Inequalities
Education 
Housing 
Employment 
Lifestyles 
Family/ community
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38
Q

Examples of health protection?

A 
Infectious diseases
Chemicals and poisons
Radiation 
Emergency response
Environmental health hazards
39
Q

Examples of health care?

A 
Clinical effectiveness
Efficiency 
Service planning 
Audit and evaluation 
Clinical governance 
Equity
40
Q

What are the three levels of public health intervention?

A

Individual
Community
Ecological

41
Q

What is the individual level of PH intervention?

A

e.g. childhood immunisation: the injection is delivered to each individual child

42
Q

What is the community level of PH intervention?

A

similar to ecological level but delivered at the local or community level e.g. installing a playground for the community children

43
Q

What is the ecological level of PH intervention?

A

(population level) e.g. clean air act, smoking in public places ban. General interventions not specifically delivered at the individual level

44
Q

What is opportunity cost?

A

To spend resources on one activity (e.g. heart transplant) means a sacrifice in terms of a lost opportunity cost elsewhere (e.g. fewer hip replacement)

45
Q

What is opportunity cost of an activity?

A

the sacrifice in terms of the benefits foregone from not allocating resources to the next best activity

46
Q

What is economic efficiency?

A

Achieved when resources are allocated between activities in such a way as to maximise benefit

47
Q

What is economic equity?

A

About what is fair and just

Improving equity often leads to a loss of efficiency (equity-efficiency trade-off)

E.g. funding treatment for a very rare disease is more expensive and means that money is less available for treating a more common disease where the benefits will be much greater for the same cost. On balance there is a loss of health and this is inefficient but it’s more equitable

48
Q

What is economic evaluation?

A

The assessment of efficiency = a comparative study of the costs and benefits of healthcare interventions
Cost & effect analysed in terms of ‘increments’ or differences. Are the incremental benefits of a new treatment worth the incremental costs?

49
Q

What three ways can you measure health benefits?

A

Natural units: e.g. blood pressure/pain score/number of cases detected
QALY
Monetary value

50
Q

What is QALY and how do you work it out?

A

quality-adjusted life year
QALY combines length of life with quality of life
QALY = length (years) x quality weighting (0-1 scale)

1 QALY = 1 year in perfect health, 2 years in half perfect health etc

51
Q

Cost-effectiveness

A

Outcome measured in natural units e.g. cost per life year gained

52
Q

Cost-utility

A

Outcome measured in QALYs e.g. cost per QALY gained

53
Q

Cost- benefit

A

Outcomes measured in monetary units

54
Q

Cost-minimisation

A

Outcomes are the same in both treatments so just minimise cost

55
Q

Incremental analysis

A

Everything is relative e.g. new drug vs old drug, medical vs surgical

56
Q

How does the NHS funding threshold work?

A

When a new treatment is funded, another treatment somewhere in the NHS needs to have its funding cut to pay for it
NICE says any service closed down to fund new services probably generates around £20,000 per QALY
Therefore it only makes sense to fund new things if they provide at least 1 QALY for every £20,000 spent on it

57
Q

What is selection bias?

A

a systematic error either in the selection of study participants or the allocation of participants to different study groups

E.g. non-response, loss to follow up, heterogeneity between study groups

58
Q

What is information bias?

A

(measurement): a systematic error in the measurement or classification of the exposure or outcome

E.g. observer bias, participant (recall/reporting) bias, instrument calibration

59
Q

What is publication bias?

A

Studies with positive results are more likely to be published

60
Q

What is chance?

A

Significant associations arose by chance

61
Q

What is confounding?

A

An external factor other than the exposure affected the results

62
Q

What is reverse causation?

A

The outcome causes the exposure instead of the other way round

63
Q

What is a population approach to prevention?

A

preventative measure delivered on a population wide basis, seeking to shift the risk factor distribution curve e.g. dietary salt reduction in the total population

64
Q

What is a high risk approach to prevention?

A

seeks to identify individuals above a chosen cut off point and treat them e.g. screening for people with high blood pressure and treating them

65
Q

What is prevention paradox?

A

A preventative measure which bring much benefit to the population often offers little to each participating individual” - e.g. seatbelt wearing

66
Q

What are the different types of screening?

A 
Population based
Opportunistic
Screening for communicable diseases
Pre-employment and occupational medicals
Commercially provided screening
67
Q

Basic screening criteria

A

The condition: Important health problem with a preclinical phase and known natural history

The test: Suitable (sensitive/specific/cost-effective) and acceptable

The treatment: Effective, with an agreed policy on whom to treat

The organisation: Facilities available, cost/benefit analysis done, an ongoing process

68
Q

What is lead time bias?

A

A disease is picked up earlier with screening and so survival appears to be increased

69
Q

List the 4 types of observational studies?

A 
Case control 
Cross sectional 
Ecological 
Cohort
Independent variable not under the control of researcher for ethical reasons- draw inferences from sample population instead
70
Q

What type of studies are RCTs?

A

Experimental/ interventional studies

71
Q

What is a cohort study?

A

Prospective/ retrospective
Longitudinal
Group of people sharing a defining characteristic
Different treatment/ exposures and see if disease occurs

72
Q

What is a case control study?

A

Retrospective
Identify factors putting you at risk (the cause) of a medical condition
Case= patients with disease
Control= similar patients without the disease
Look at different factors

73
Q

What is a cross sectional study?

A 
Single point 
Observational study
analysing prevalence (data) of disease in the population/ a representative subset at a particular time
74
Q

What is an ecological study?

A

comparative
population based data rather than individual data
analysis of risk modifying factors based on:
- geographical location
- time

75
Q

Randomised controlled trial?

A

researhcer is attempting to control the independent variable

76
Q

Prevalence?

A

n.o. of cases/ n.o. population at a particular point in time

77
Q

Incidence?

A

N.o. new cases over a period of time

78
Q

What is person-time?

A

the combined number of hours/ years a population was at risk of
to calculate incidence
useful if following up people for a different amount of time due to death/ leaving the study

79
Q

What is incidence rate?

A

n.o. of persons who have become cases ina given time period/ total person-time at risk during that period

80
Q

What is attributable risk?

A

Size of effect in absolute terms
rate of disease in the exposed that may be attributable to the exposure

= incidence in exposed- incidence in unexposed

ie risk of cancer in smokers- risk of cancer in non smokers =AR

81
Q

Relative risk?

A

strength of association between a risk factor and a disease

= incidence in exposed/ incidence in unexposed

risk of cancer in smokers/ risk of cancer in non smokers= smokers … x more likely to get cancer than non smokers

82
Q

Absolute risk reduction?

similar to attributable risk?

A

n.o. of % points in your own risk goes down if you do something protective ie stop drinking alcohol

= control event rate- experimental event rate

83
Q

Relative risk reduction?

A

how much risk is reduced in an experimental group compared to a control group

= (control event rate - experimental event rate)/ control event rate

84
Q

What is number needed to treat?

A

Average number of patients who need to have the treatment for one of them to get a positive outcome

= 1/ Absolute risk reduction

85
Q

What is number needed to harm?

A

Measure of the chance of experiencing a specified harm in a specified time because of the treatment or other intervention

86
Q

Types of measurement bias?

A

Observer- ie incorrectly recording values
Participant- recall bias
Instrument - wrongly calibrate

87
Q

What is a confounding factor?

A

variable that influences both the dependent and independent variable, causing a spurious association

88
Q

What’s dose response?

A

Does the effect increase with an increased dose?

89
Q

What is consistency/ reproducibility?

A

Is the experiment reproducible by others?

90
Q

What is temporality?

A

Does the effect relate in time to the suspected cause?

91
Q

What is reversibility?

A

Does stopping the variable cause a reversal of the effect?

92
Q

What is biological plausibility?

A

Is there a biological mechanism which would cause this?

93
Q

What is reverse causality?

A

Does the variable you are exploring cause the outcome or does the outcome cause the variable?
Ie HTN cause increased stress or other way round

94
Q

What are dose-response, strength, consistency, temporality, reversibility, biological plausibility all part of?

A

Bradford Hill Criteria for causation

public health 3a (1 decks)

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