QI Flashcards
Level of evidence
Systems
Summaries
Synthesis
Studies
Base rate effect
Look for more exotic diseases and ignore more common
Framing effect
Patient comes up “packaged” from the ED and it is not questioned further
Framing effect
Patient comes up “packaged” from the ED and it is not questioned further
Transformative learning theory
uses critical reflection to challenge a learner’s belief
Cogntive learning theory
focused on the mental aspect of learning
Clinical Learning Environemnt
Safety
Supervision
Well being
Teaming
Health care quality
Belmont research 3 tenets
What added later
Respect/autonomy
Beneficience
Justice
Nonmalecience
Relative Risk
Incidence of disease in exposed to risk
over incidence of disease in unexposed
Emmanual Principles of Allocation
- Improving health outcomes
- Reduce conflict of interest
- Patients should be informed
- Patients should be able to consent
Type I error
Rejecting the null hypothesis (saying there is a difference when there is not one) a false positive
What is a measure of chance?
p value < 0.05
Type II Error
Errounsaly accepting null hypothesis, saying there isn’t difference when there is one
Power
how likely you are to be right, ability of a study to detect a difference that is present
Power is 1- beta
80%
T test
Cohort studies- can calculate what?
Need large population
Prospective or retrospective observational patients when outcomes emerge
Relative Risk Risk of exposed/unexposed
Case control- can calculate what?
Have outcome, seeing what risk factors caused
Good for rare evens
Can’t do relative risk because manipulating the incidence
Odds Radio
T test
Univariate
One continous and one categorical (with only 2 values)
ANOVA
Univariate
One continous and one categorial with multiple values
Chi-square
Univariate
2 categorical variables
Kaplan Meier Curve and Log Rank Test
Univariate
Time variable and categorical
Linear Regression
Multiple variables
Continous
Logisitic Regression
Mutlivariate Categorial
Cox proprotional
Time, surivial curge
Ratios over 1 vs less than 1
> 1 more likely of outcome in exposed
<1 less likely in exposed
What can affect internal validity
Bias, chance, condounder
What can affect external validity
selection bias
ROC
Y axis sensitivity
X axis 1- specificity
The more area under the curve the better the test because maximizing sensitivity without losing specificity
Likelihood Ratio
Prest prob X LR : Post test probability
Specificity
SPIN
TN/TN+FP
A positive test rules in, good for confirmation
Sensitivity
SNOUT
TP/TP+FN
A negative rules out, good for screening
PPV
TP/TP + FP
prevalence plays in
Likelihood a positive test has the disease
NPV
TN/TN+FN
prevalence plays in
Likelihood a negative has the disease
Pediatric Assessment Triangle
Appearance
WOB
Circulation
Lewain Change Management Model
Unfreeeze
Change
Refreeze
Institute of Medicine (IOM) 6 Dimensions of HealthCare
3 E’s
Efficient
Efffective
Equity
2 P’s
Patient safety
Patient centered
1 T
Timeliness
Confidence Interval
research study represents a range of values that is likely to include the true value. Confidence intervals are typically set at 95%
Lean Methodology
All about reducing waste, stream mapping, eliminating non-value added work
Six Sigma
QI improve processes. keep 6SD away from failure
Define
Measure
Analyze Improve and control
Process mapping =
= Flowchart
the steps to an outcome
Cause and effect =
Fishbone
Looking at ALL factors thaat contribute
Paretto
Which factors are most important
Key driver
AIM with primary drivers and secondary drivers
Secondary drivers- what you are doing diretly
Primary drivers- people things
Failure mode analysis
What can lad to failure or negatively impact study
Scatter diagram
after QI can show correlation show results and
SMART AIM
Specific
Measurable
Achievable
Realistic
Time Bound
High reliability organization
Functions in high complex high hazard domains for extended periods of time without serious accident or failure
Best style for feedback
Instrumental
Summartive Feedback
Grade evaluation
Formative feedback
Improvement through out
Team mentoring
Many mentors one mentee
Assent?
Understanding the situation
Implicit bias reduce
Partnership building
Mindfulness
Highest level of racism
Structural above institutional