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Block 1

Terms in this set (85)

Consequentialism
ends are the evaluative measure
Utilitarianism
type of consequentialism; optimize greatest good for greatest number of people
Justice
benefits of treatments should be available to all
Beneficence
intent to do good
Nonmaleficence
Do no harm
Autonomy
Patient has final say over decision-making
Feminist Ethics
decision-making is not individualistic, and must take into account surrounding circumstances/relationships
Casuistry
compare two cases to each other, exploring distinctions to make ethical decisions
Virtue Ethics
ethical development of an individual's character through moral education
Public Health vs. Population Health v. Population Medicine
public efforts to achieve population health

the distribution of health outcomes of a group resulting from a variety of efforts including public health

clinical approach to achieving population health (ie. aiming to prioritize screening for my patient pool)
Disease
medical abnormality/sickness
Illness
patient experience with being sick
Primary Prevention
no disease involved
i.e. vaccines
Secondary Prevention
interrupting asymptomatic disease
i.e. screening
Tertiary Prevention
response to symptomatic disease
i.e. post-op rehab
Quaternary Prevention
prevention of unnecessary treatment
i.e. avoid indiscriminate antibiotics
Criteria for Screening
disease: serious, treatment exists, not too rare
hospital: continuous treatment for all
test: safe, cheap
USPSTF
US Preventative Services Task Force

recommends certain screenings based on efficacy literature
Epigenetics
environmental exposures can alter gene expression thru methylation/acetylation
Endocrine-Disrupting Chemicals
mimics presence of natural hormones, accelerating development --> early Menarche
Social Determinants of Health
nonmedical aspects of life that are the structural roots of health inequities, shaped by the distribution of resources in communities
Status Syndrome
higher social position = better health
Social Gradient of Health
more homogenous communities have more health equality b/c less variability in risk level
Allostasis
the process of achieving stability or homeostasis through physiologic or behavioral change
Allostatic load
wear and tear that results from allostasis; blacks have higher allostatic load --> higher disease levels
Examples of SDoH that affect equity
(1) low education = low health
(2) low income = higher risk of disease
(3) dangerous occupational environment = higher risk of exposure disease
Examples of Health Equity efforts in CLE
Healthy Eating/Active Living -- bike paths/parks and better access year-round to healthy foods

Birthing Beautiful Communities -- birth attendants to aid African American pregnant mothers
Examples of Public Health interventions
- Public smoking laws
- trans fats in foods
Prevalence
# of cases at a point in time
Incidence
# of new cases in a set amount of time
Cumulative incidence
proportion of population experiencing new outcome
Incidence Rate
rate at which new cases develop (# of cases/time period)
Mortality
total number of deaths // total population
Proportionate Mortality
deaths due to disease // total deaths
Case Fatality
deaths due to disease // # of people with disease
Criteria for Causality
(1) strength of association
(2) consistency/generalizability
(3) temporal relationship
(4) dose/response
(5) biological plausibility
Chance
p-value; probability that the observed relationship is based on chance alone (ie. stat insignificant)
Bias
error in subject selection or data collection
(ie. selection, performance, recall - subjects have different ability to recall exposure)
Confounding
alternative factor that explains relationship
Type 1 Error (α)
"you think you are alpha but you are not" - ie. FALSE POSITIVE
Type II Error (β)
"you think you are not an alpha, but you actually are" -- ie. FALSE NEGATIVE
Sensitivity
a / (a*c)
Specificity
b / (b*d)
PPV
a / (a*b)
NPV
c / (c*d)
Descriptive Study
describe distribution of characteristics; ignores causality/association -- purely observational
Case Series
- detailed descriptions w/o control group
- describes how common a disease is, good for hypothesis formation
- questions generalizability
Cohort
IDENTIFY GROUPS BY EXPOSURE
- groups w/ and w/o exposure are compared to assess prevalence of outcome
- good for rare exposures, bad for rare outcomes
- establish temporal relationship
- time consuming
- performance bias (treat groups differently)
- Hawthorne effect (behave differently when watched)

- relative risk and odds ratio
Case Control
IDENTIFY GROUPS BY OUTCOME/DISEASE
- groups with outcome are compared whether or not they had certain exposure
- good for rare outcomes, bad for rare exposures
- Recall bias (subjects remember differently)

- odds ratio
Odds Ratio
(ad)/(bc)
RCT
- most generalizable
- expensive
- double blind eliminates bias

- relative risk and odds ratio
Probability
likelihood of something occurring
Variation
less variation = more statistical power
Statistical Significance
probability of making a type I error (false positive) -- if p < 0.05, then it is statistically significant

the ability to detect a difference if, in fact, a difference exists -- rejecting null hypothesis when it is right to reject
Confidence Interval
range of values that you are x% confident that the true value falls in between
Lead Time Bias
early detection confused w/ increased survival
Length Time Bias
screening less aggressive diseases confused with reduced mortality
Out-of-pocket
US system; patients access to care based 100% of their ability to pay on their own
Bismarck Model
France/Germany system and US private insurance; private insurance covers patients' care (private + public providers) thru premiums
National Health Insurance
Canada system and Medicare; private/public providers reimbursed thru tax revenue FFS
Beveridge Model
UK and VA models; public providers salaried cover care, financed by tax revenue
ACA insurance provisions
(1) Medicare VBP and Bundled Payments
(2) expansion of Medicaid;
(3) kids up to 26 covered under parents;
(4) HC insurance exchange (transparency)
(5) premium subsidies
(6) can't deny based on pre-existing conditions
(7) individual mandate prevents adverse selection
(8) guarantees preventive services as declared by USPSTF
Fee For Service
physicians are reimbursed based on the individual services provided; incentivizes overmedicalization
Value-Based Purchasing
mechanism to reimburse based on quality metrics to promote quality over quantity of care
PCMH
patient-centered medical home; focuses on interdisciplinary coordinated care; much more emphasis on primary care
ACO
network of physicians for coordinated care; much broader than PCMH, include full spectrum of care; reimbursement model to encourage cost/quality accountability

following core of Triple Aim (cost, quality, population access)
Triple Aim
(1) experience of care; (2) cost; (3) population health
Readmission Reduction
part of VBP, where quality metrics used to dictate reimbursement
Bundled Payments
fixed payment for episode of treatment, shifts burden of cost reduction onto care providers; prevents overmedicalization
HDHP
high deductible insurance plans; high cost burden on the patient with low premium -- "catastrophic"
Coinsurance
% of full cost paid by patient
Copay
flat fee per encounter
HSA
health savings account; accumulation of funds over time as a savings fund for catastrophic circumstances
Adverse Selection
sick patients try to get lumped into the healthy group for lower rates, and the healthy people opt of uninsurance
Moral Hazard
insurance leads to more risky behavior and higher consumption of health care
Shared Medical Appointment
part of PCMH experience, multidisciplinary team offer group appointment to several patients to improve quality of visit, time efficiency
Institute of Medicine 6 aims
S - safety;
T - timeliness;
E - effectiveness
E - efficiency
E - equity
P - patient-centeredness
PDSA
Plan - define intervention
Do - test intervention
Study - evaluate results of intervention
Act - adapt intervention and try again
Root Cause Analysis
find out what happened and WHY - how to prevent moving forward
Process measures
assessments of activities carried out by HCPs to deliver services (ie. pap smear frequency data)
Outcome measures
assessment of health state of patient resulting from healthcare
Types of medical errors
(1) hand-off
(2) surgical
Safety Net
catch-all mechanism to support care for uninsured or publicly insured (i.e. EDs or Medicare/Medicaid coverage)
MACRA
Medicare Access and CHIP Reauthorization Act of 2015; transitions into value-based payment programs and merit-based incentive program - FFS adjusted for quality metrics (MIPS)
FQHC
federally qualified health center;
ACA created lots of growth in FQHC
primary care safety net to help uninsurance
FQHC enhanced reimbursement for Medicare pts
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