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CDCES > SOC 1: improving care & promoting health in populations > Flashcards

SOC 1: improving care & promoting health in populations Flashcards

1
Q

What % of Americans are overweight? obese?

A

34% for each

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2
Q

Assessing social context includes:

A
  • food insecurity
  • housing stability
  • financial barriers
  • language barriers
  • community resources to refer to
  • referring to lay health professionals as available
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3
Q

Health inequalities are caused by:

A

economic
environmental
political
social conditions (where people live and work)

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4
Q

What is population health?

A

Health outcomes of group of individuals, including distribution of health outcomes within a group

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5
Q 
What is the DPP?
How often did it meet?
What were the intervention groups?
What were the targeted outcomes/behaviors?
What did it find?
A
  • Diabetes Prevention Program
  • 1st 6 months- 16 meetings
  • Metformin vs. placebo vs. lifestyle change group
  • Lifestyle change group- 7% weight loss, 150 minutes PA/week, low kcal/low fat diet
  • after 3 years, DPP lifestyle change group reduced change of T2DM by 58%
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6
Q

When is DPP covered by Medicare?

A
  • Overweight or obese +

- lab test reflecting pre-DM w/in past 1 year

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7
Q

What is the DCCT trial?
What type of DM did it target?
What did it set out to accomplish?
What were the outcomes?

A
  • Diabetes Control Complications Trial
  • T1DM
  • intense insulin regimen (3+ daily injections or pump) to achieve near euglycemia versus conventional tx
  • intensive tx –> 3x higher hypo risk however it did not reduce QOL/function
  • suggests intensive insulin tx reduces LT complications
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8
Q

What is the UKPDS?
What type of DM?
Set out to accomplish?
Outcomes?

A
  • United Kingdom Prospective DM study
  • T2
  • effect of intense glycemic control on incidence of complications
  • Fasting 100 versus 270 using meds/insulin and/or lifestyle, whatever needed
  • Intense BG control reduced DM end points, especially microvascualr dx by 25% however did not reduce mortality
  • any amount of BG improvement beneficial
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9
Q

Look AHEAD- what is it?
who were the participants?
what was the intervention?
outcomes?

A
  • overweight T2DM participants
  • aim for 7% BW loss, >/= 175 minutes/week of MIPA; intent to reduce CV
  • 1st 6 months- 2 meal +1 snack replacement, 1 1:1 & 3 group sessions/month
  • months 7-12- 1 meal replacement, 1 1:1 + 2 group/month
  • year 2-4- 1 individual/month + 1 pone contact
  • year 4-11- 1 1:1 month
  • No significant changes found in CV morbidity and mortality
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10
Q

What are 3 ways to assess population health?

A
  • Health outcomes (mortality, morbidity, health, functional status)
  • Dz burden (incidence, prevalence)
  • Behavioral/metabolic factors (exercise, diet, A1c)
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11
Q

Hierarcy to improve population health

A

policy level
system level
patient level

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12
Q

SDOH

A

Outside direct control of individual

must be addressed to improve health outcomes

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13
Q 
What % of PWD met:
HgbA1c goals
BP goals
LDL goals
non-smoking
all of the above
A 
A1c- 70%
BP- 70%
LDL- 55%
non-smoking- 85%
all of the above- 20%
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14
Q

Who is least likely to meet tx targets?

A

YA
Women
Non-hispanic African Americans

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15
Q

Why is the current healthcare system ill equipped to handle DM?

A
  • duplicates services
  • lacks clinical information technology
  • fragmented
  • poorly designed to coordinate care
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16
Q

6 core elements to optimize care of PWD

A
  • reactive –> proactive care
  • SM support
  • decision support
  • pt registries
  • community resources
  • health systems
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17
Q

What are the impacts of the Chronic Care Model on CVD risk, microvascular complications, mortality, cost?

A
  • CVD risk dec. by 55%
  • Microvascular complications dec. by 10%
  • mortality decreased by 65%
  • saved 7,000 over 5 year period per person
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18
Q

Strategies for system level improvement

A
  • track medication taking behavior
  • use evidenced based guidelines
  • use EHR
  • empower and educate pts
  • remove financial barriers (out of pocket cost for DM ed, eye exams, DM technology, necessary meds)
  • community resources
  • public policies
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19
Q

Who does the care team in CCM center around?

A

Client

20
Q

Goal setting should be

A

SMART goals
collaboratively set w/ pt
explicitly stated

21
Q

How common is cost related under usage in insulin users?

A

25%

22
Q

How common is financial stress & food insecurity in PWD?

A

$$ stress- 50%

Food insecurity- 20%

23
Q

What is food insecurity?

A

Unreliable availability of nutritious food, inability to obtain w/o reporting to socially unacceptable practices

24
Q

Who is most likely to be food insecure?

A
  • racial/ethnic groups -B/AA, H/L
  • low income households
  • single mother households
25
Q

DM MGMT challenges in those who are food insecure

A
  • low adherence to taking meds and SMBG
  • binge eating
  • inexpensive CHO processed food intake
  • erratic CHO –> hypo especially if on insulin or sulfonylurea
26
Q

Affordable care act increased care for individuals with DM from ____% to ____ %

A

84 –> 90

27
Q

What % of PWD reported financial stress?

A

50

28
Q

What % of PWD report food insecurity?

A

20

29
Q

Mental illness such as schizophrenia and bipolar are how many x’s higher in PWD?

A

2-3x

30
Q

For whom should Metformin be considered?

A

BMI >35
History GDM
<60 years old

31
Q

Participating in DPP –> ?

A

58% reduced risk of T2DM

32
Q

What are recommendations for flu vaccine?

A

Q year starting at 6 months

33
Q

What is the recommendation for Hepatitis B

A
  • give 2-3 dose series for unvaccinated adults 19-59

- consider 2-3 dose for unvaccinated adults 6-+

34
Q

How much higher risk for Hep B?

A

2x

35
Q

Who should get PCV13?

A

babies before 2 years of age

36
Q

Who should get PCV 23?

A

Age 2-64 then again >/= 65

37
Q

What % of Medicare pts receive DMSME?

A

5-7%

38
Q

After what age to start depression and cognitive impairment screening?

A

65+

39
Q

The DCCT concluded that A1C <7% reduced
eye dz
kidney dz
nerve dz

A

eye- 75% reduced risk
kidney- 50%
nerve- 60%

40
Q

UKPDS found that:

1% decrease in A1c decreased microvascular complication by what AND decreased deaths by what?

A

35% and 25%

41
Q

UKPDS found that BP in low 140’s/low 80’s reduced risk of what?

A

Heart failure- 55%
Stroke- 45%
Death from DM- 1/3

42
Q

What is the leading cause of mortality and morbidity in DM?

A

CVD

43
Q

What age can ASCVD risk factor be used?

What is it?

A

40-59

Estimates 10 year risk of CV event

44
Q

What was the mean A1c 2007-2010?

A

7.2%

45
Q

How much Medicare $ go toward DM?

A

1/3

CDCES (13 decks)

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