Social Sciences Flashcards
Model for improvement
incremental cycles of planning, piloting, assessing and refining an intervention to achieve a specific goal
ie. testing a new check in procedure with weekly tabulation of patient satisfaction surverys
Lean (quality improvement process)
Identification and removal or inefficiency and waste in workflow
ie streamlining scheduling to reduce excess waiting time , delays, no shows
six sigma (quality improvement)
near elimination of defects through statistically driven process improvement
ie. controlling annual incidence of wrong site surgery to <0.00001% through enhances safety measures
change management (quality improvement )
engaging personnel to adopt innovation and implement organization changes
ie. identifying frontline early adopters to lead implementation of the new EHR system
(100-specificity)=
false positive rate
specificity = 95 then 95% of people without disease will be correctly identified as not having disease
5% of people without disease will be incorrectly identified as having the disease
(100-sensitivity)=
false negative rate
for something to be a confounder it must be linked to what
both the exposure and the outcome of interest (it is not evenly distributed)
High sensitivity = _ false negative
low
Low sensitivity= _ false positive
high false positive rate
prescriptions for elderly patients should consider the medications what
magnitude of effect
time to therapuetic benefit
patient health status
goals of care
adverse drug reactions
how many outcomes can case-control studies evaluate
1
for patients with delirum and agitation how do you prevent falls
with close direct supervision
1:1 patient supervision within direct line of sight of nurses
frequent supervised toileting in patients with incontinence
optimizing the room environment (low bed, lights bright during the day and dimmed at night in dementia patients)
in patients with delirum and agitation what should you avoid when preventing falls
avoid using restraints or raising bed rails
how can a physician assist distressedf surrogate decision makers?
guiding them in applying substituted judgement
by refocusing the discussion ask what the patient was like before the illness (tell me about what she was like and what kind off goals of care she would have wanted)
help the surrogate apply their knowledge of the patients goals to the situation
emphasize shared decision making
genetic testing in children for diseases that have childhood onset vs. adult onset
child onset: test right away (like CF)
adult onsent (BRCA 1 breast cancer) - test later when the child is old enough to understand the risks and benefits of testing (to ensure informed consent)
Provision of clinical services primarily to reduce physician liability without significant benefit to the patient
defensive medicine
(leads to overuse with worse patient outcomes and higher costs)
liability concerns in defensive medicine is addressed by
implementing clinical pathways or practice guidelines (evidence based recommendations for common conditions)
what are the 4 indicators used in quality measurement to discover why suboptimal results are occuring
structural indicators (clinican knowledge, nurse to patient ratio)
process indicators (variations and compliance)
outcome indicators (measures in health status/outcomes)
balancing indicators ( measure of tradeoff incurred as a result of a system change)
pay for performance systems intend to improve health care outcomes by linking financial incentives to delivery of evidence based care however, for these systems to improve orverall quality of care they must address what
equity (patient population)
need to consider demographic characteristics when determining the amounts of incentive payments to give physician.
what diseases need airborne precautions
tuberculosis, varicella, herpes zoster, rubeola
what do airborne precautions involve
N95 respirator and negative pressure isolation room
