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Population Health > Test 2 > Flashcards

Test 2 Flashcards

1
Q

describe TOC

A

movement of pt between a healthcare system and providers. ensure coordination among healthcare professionals

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2
Q

pre-discharge

A

med rec, pt edu, discharge planning, scheduling follow-up

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3
Q

post-discharge

A

follow-up phone call,

communication with ambulatory provider, home visits

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4
Q

bridging

A

transition coach that acts as a patient advocate, patient-centered discharge instructions to increase patient buy-in, clinician continuity with inpatient/outpatient providers, transition coach may attend follow up visits

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5
Q

groups at high risk for adverse drug events within care transitions

A

older adults, limited health literacy, terminal patients, children with special needs, patients taking more than 5 meds daily, cognitive impairment, complex medical/behavioral health conditions, lower income, new admits to LTCF, homeless

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6
Q

pharmacists role in TOC

A

med reconciliation: comparing med history and what physician has ordered at admin, transfer, discharged to avoid omissions, errors, duplicates, and ADE

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7
Q

pharmacists role at admin

A

identify outpatient meds (history), assess adherence and health literacy, reconcile with current medical state

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8
Q

pharmacists role at inpatient transfer

A

ensure adequate hand-off to ensure continuity between

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9
Q

pharmacists role at discharge review

A

med list correct and optimized based on inpatient changes, counsel, assess access to medications, promote adherence, follow-up

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10
Q

community pharmacist activities after discharge

A

perform home visits, review automated refill programs, help with interpretation of discharge paperwork, assist with third-party formulary review

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11
Q

create a plan for improving medication management during TOC

A
  • start patient education earlier (days before discharge), use established educational techniques, follow-up with patient after discharge
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12
Q

Comparative Effectiveness Research (CER)

A

CER is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or improve the delivery of care. Purpose is to inform decisions that will improve healthcare at both the individual and population levels

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13
Q

1972 CER

A

establishment of the Office of Technology Assessment (OTA), an advisory committee to Congress tasked with evaluating the effectiveness of healthcare services

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14
Q

1975 CER

A

establishment of the National Center for Healthcare Technology (NCHT) with the purpose of endorsing research on health technologies

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15
Q

1989 CER

A

establishment of what came to be known as the Agency for Healthcare Research and Quality (AHRQ) to facilitate the development of timely evidence and update clinical practice guidelines

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16
Q

2003 CER

A

Medicare Prescription Drug, Improvement, and Modernization Act (MMA) mandates that the AHRQ conduct research into effective healthcare programs

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17
Q

2009 CER

A

American Recovery and Reinvestment Act provided funding for CER, mandated the establishment of the Federal Coordinating Council for CER, and required the IOM to report back to Congress within a few months of passage

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18
Q

2010 CER

A

establishment of the Patient-Centered Outcomes Research Institute (PCORI), a non-profit, independent organization to fund CER initiatives

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19
Q

American Recovery and Reinvestment Act legislated efforts for CER

A

increased funding for CER by 1.1 billion
established federal coordinating council for CER
purpose: help agencies of the federal government in coordinating comparative effectiveness and related health services research
agencies: AHRQ, NIH, CDC, CMS, FDA, VA
coordination functions: research infrastructure, methods and workforce development

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20
Q

efficacy- CER

A

health care intervention is beneficial when administered under optimal circumstances. efficacy is whether or not something works under carefully controlled conditions.
Efficacy studies have strict inclusion/exclusion criteria, involve highly standardized treatments, have explicit procedures for ensuring compliances, and focus on direct outcomes.

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21
Q

RCT

A

The gold standard of generation of efficacy data is through randomized clinical trials (RCTs).

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22
Q

Effectiveness - CER

A

health care intervention does more good than harm when provided to a wide assortment of real-world patients with different baseline health risks by physicians or other care providers practicing in diverse clinical settings. effectiveness is how well something works under actual conditions.
Effectiveness studies have looser inclusion/exclusion criteria, involve treatments carried out by typical clinical personnel, have little or no provision for ensuring compliance, and focus on less direct outcomes (e.g., quality of life).

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23
Q

Generation of effectiveness data is done through

A

effectiveness trials, pragmatic trials, and observational studies.

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24
Q

tenets distinguish CER from clinical research in general

A
  • informs a specific clinical decision from the individual patient perspective or health policy decision from the population perspective
  • compares two alternative interventions that provide benefit
  • describes results at the population and subgroup levels
  • measures outcomes - both benefits and harms - that are important to patients and decision makers
  • employs methods and data sources appropriate for the decision of interest
  • conducted in settings that are similar to those in which the intervention will be used in practice
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25
Q

Range of CER methods

A
  1. Experimental studies, RCT, assigned treatments, practices, policies
  2. Prospective observational studies - registries, observe patterns and of care and outcomes - do not assign patients to specific study groups
  3. Retrospective studies
  4. Decision models with or without cost info
  5. Systematic reviews of existing research including meta-analyses
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26
Q

Stakeholder

A

Individuals, orgs or communities that have a direct interest in the process and outcomes of a project, research, or policy endeavor

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27
Q

Stakeholder engagement

A

Iterative process of actively soliciting the knowledge, experience, judgement and values of individuals selected to represent a broad range of direct interests in a particular issue, for the dual purpose of:

  • creating a shared understanding, and relevant, transparent, and effective decisions
  • making relevant, transparent, and effective decisions
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28
Q

Stake holder categories in CER

A

Patients/consumers, clinicians, healthcare providers, payers/purchasers, policy makers/regulators, life sciences industry, researchers, research funders

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29
Q

Considerations for CER question

A

Population, intervention, comparator, outcomes, timing, setting

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30
Q

Future implications

A

Participatory research methods may produce evidence-based interventions

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31
Q

Healthcare orgs can advance CER by investing in

A
  1. Personnel dedicated to data collection, monitoring, and interpretation
  2. Data infrastructure / analytics
  3. Evidence-based quality improvement initiatives
  4. Adaptive implementation and dissemination strategies
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32
Q

Race

A

Physical characteristic and/or genetic or biological makeup
Social, not scientific construct
Developed in notions of racial superiority
In 2010 census includes 15 racial categories

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33
Q

Ethnicity

A

Characteristics of people who share a common and distinctive racial, national, religious, linguistic, or cultural heritage

Geographic origins, family patterns gender roles, religion, literature/music, employment, language/ symbols, values / cultures

34
Q

What are the 2 ethnic categories in the US census

A

Hispanic / non-Hispanic

35
Q

Culture

A

Integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups

Culture is learned, passed from generations, complex, subcultures

36
Q

Cultural considerations in healthcare

A 
Perceptions of health/illness
Why illness occurs
Health behaviors 
How symptoms are described / how concerns are expressed
Treatment is pursued and followed
37
Q

Why do we have unconscious bias

A

Storing social knowledge from experience and learning
Familiar cues trigger an association with stored social knowledge
Automatic application of social knowledge to a current situation

38
Q

Health literacy

A

The degree to which individuals have the capacity to obtain, process,and understand basic health information needed to make appropriate health decisions

39
Q

Literacy impact areas

A

Med non-adherence
Identification of meds
Limited understanding of instruction
Increased med errors

40
Q

Health, health care, and health equity impact (limited literacy)

A
  • negatively impacts online access and use
  • hinders patient - provider communication
  • reduces opportunity for self-care
  • negatively impacts health services navigation
  • impedes understanding of health info
41
Q

Patient protection and affordable care act section number and about

A

Sec 3507, presentation of prescription drug benefit and risk information, directs the secretary to determine whether the addition of certain standardized information to prescription dug labeling and print advertising would improve health care decision-making by clinicians and patients and consumers; to consider scientific evidence on decision-making and to consult with various stakeholders and experts in health literacy

42
Q

Healthy people

A

HC/HIT- 1.1-3 - easy to understand instructions, US department of health and human services

43
Q

National action plan to improve health literacy

A

All-inclusive approach to reach goals - all people have the right to health info that helps them make decisions, services should be delivered in a way that is easy to understand

44
Q

Health literacy online

A

Various grade levels, guide for designing online resources for all health care consumers

45
Q

Health literacy workgroup

A

Dedicated to improving literacy in the US and resource for national health care agencies

46
Q

Health literacy workgroup

A

Workgroup dedicated to improving literacy in the US and a resource for national health care agencies

47
Q

AHRQ patient assessment tools

A

Patient edu materials assessment tool for printable materials
Short assessment of health literacy - Spanish and english
Rapid estimate of adult literacy in medicine
Short assessment of health literacy for Spanish adults

48
Q

Pharmacists expectations and system demands

A

Managing medications, remembering and following spoken and written directions, interpretation

49
Q

Adult skills - literacy

A

Majority of U.S. adults have trouble using print materials to do everyday tasks 0 calculate 15% tip (quantitative)
Reading medication how much to give to a child, etc

50
Q

Proficient literacy

A

Define medical terms from a complex document, calculate share of employee’s health insurance costs

51
Q

Intermediate literacy

A

Determine healthy weight from BMI chart, interpret prescription and OTC labels

52
Q

Basic literacy

A

Understand simple patient edu handout

53
Q

Below basic literacy

A

Circle date on appointment slip, understand simple pamphlet about pre-test instructions

54
Q

High-risk health literacy groups

A

No English, homeless, prisoners, limited edu, limited English proficiency (LEP), patients, minorities

55
Q

We expect patients to…

A

Read labels etc
Track experiences - side effects, take action
Calculate- count dose, time, amount left

56
Q

Patient-level consequences with literacy

A

Poorer health outcomes, missed refill, emergency care use, difficulty understanding meds

57
Q

Medication errors - what you should say

A

How do you take this medicine, how many pills in one day

58
Q

Societal consequences with poor health literacy

A

Non-adherence, inc ED costs among low health literacy patients, undermines efforts to increase patient self-management and engagement in care

59
Q

Pharmacy consequences to poor health literacy

A

Impact on customer loyalty and satisfaction, decreased profits due to missed refills, liability

60
Q

Pharmacoepidemiology

A

Study of the use and effects of drugs in populations. Post marketing surveillance - seek to quanitfy drug utilization patterns, conduct safety studies to examine drug safety and ADE

61
Q

Pharmacoepidemiology Rationale

A

Med costs inc, polypharm, cost-effective care, unethical to conduct some studies using experimental format

62
Q

Users of pharmacoepidemiology research

A

Gov, pharm industry, practitioners, academics, attorneys, consumers, international users

63
Q

Phases of pharmacoepidemiology through drug development and post marketing

A
  1. Preclinical - IND
  2. Phase 1- safety - healthy volunteers
  3. Phase 2- efficacy- 100-200 puts with disease
  4. Phase 3 - dosing/population studies - >500 puts with disease
  5. NDA - post marketing
64
Q

FDA approval process limitations

A

Based on clinical trials
May exclude important age groups of patients - children/women of child-bearing age
- sample sizes
- short duration

65
Q

Post marketing surveillance

A

Gathering info about a product after it has been approved for public use

  • process for measuring drug safety after FDA approval identify potential problems
  • info gathered via phase 4 clinical trials, post-marketing studies, and adverse event reporting systems
  • pharmaceutical companies must report to the FDA annually on the progress of their post-marketing studies
66
Q

Pharmacoepidemiology during postmarketing

A

Evaluate safety signals, describe drug utilization in populations (adherence/off-label use), examine adverse events, develop post-authorization safety studies (PASS)

67
Q

Adverse event reporting systems

A

FDA has established medwatch/VAERS safety
Voluntary system
Purpose: identify and evaluate risk with a specific product, develop interventions to modify the risk, and communicate risk

68
Q

Other reporting systems

A

Spontaneous reporting pharmaceutical companies, case reports

69
Q

Spontaneous event reporting limitations

A

No control group, hard to estimate frequency / rate at which the drug effect occurs, no adequate info about drug exposure, no causative association, potential bias, voluntary, inc healthcare informatics/databases

70
Q

Potential pharmacoepidemiology research questions

A

Patterns of use, safety, effectiveness, economic evaluations

71
Q

Examples of outcomes of post market ADE reporting

A

Product recall, boxed warning, contraindications, new warnings, precautions, ADE, dose adjustments, letters to health care professionals

72
Q

Pharmacists role

A

Drug experts, identify problems, ADE reporting, interpret PE studies, conduct drug use evaluations; develop guidelines, medication adherence proponents, conduct pharmacoepidemiology cal research

73
Q

CER 1972

A

establishment of the office of technology assessment (OTA), advisory committee to Congress tasked with evaluating the effectiveness of healthcare services

74
Q

CER 1975

A

national center for healthcare and technology (NCHT) purpose of endorsing research on health technologies

75
Q

CER 1989

A

establishment of what is known as the Agency for Healthcare Research and Quality (AHRQ) to facilitate the development of timely evidence and update clinical practice guidelines

76
Q

CER 2009

A

American Recovery and reinvestment act provided funding for CER , mandated the establishment of the federal coordinating council for CER and required the IOM to report back to congress within months of passage

77
Q

CER 2003

A

medicare prescription drug, improvement, modernization act (MMA) mandates that the AHRQ must conduct research into effective healthcare programs

78
Q

CER 2010

A

establishment of the patient-centered outcomes research institute (PCORI), a non-profit, independent organization to fund CER initiatives

79
Q

American Recovery and Reinvestment Act legislated efforts for CER

A

increased funding for CER by 1.1 billion
established the federal coordinating council for CER
purpose: assist agencies of the federal gov in coordinating comparative effectiveness and related health services research
agencies: AHRQ, NIH, CDC, CMS, FDA, VA
coordination functions: research infrastructure, methods and workforce development

80
Q

efficacy with respect to CER

A

extent to which a health care intervention is beneficial when administered under optimal circumstances. whether or not something works under carefully controlled conditions.
- strict inclusion/exclusion criteria, procedure, focus on direct outcomes, gold standard of generation of efficacy data through randomized controlled

Population Health (3 decks)

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