1- H&S Flashcards
determinants of health for Healthy People 2020
From LG: 5 determinants of health which all contribute to Health Outcomes
Physical environment
Social environment: conditions in the environment in which people are born, live, learn, play, work and age
Individual behavior
Health services: access and quality, insurance, etc
Biology and genetics
Economic stability Education Social and community context Health and health care Neighborhood and built environment
Charges Costs Payments Input costs Fixed costs OOP costs Value
Charges: The list price (i.e. $300)
Often much higher than what is actually paid by those with insurance, but sometimes charged to those without insurance
Costs: The actual amount paid for a service (i.e.$200)
Also called “payments” or “spending”
Will vary based on insurance, which if present may pay for a portion of the cost. The rest are out of pocket costs to the patients
Cost to insurer/reimbursement = $180
Cost to patient/out of pocket spending = $20
Payments: Another word for cost
Input costs: Input cost is what it costs the doctor (i.e $150)
Fixed costs - overhead, equipment, building costs, etc.
Variable costs - salaries, benefits, supplies, medications, etc.
Out of pocket costs: The cost the patient has to personally pay, such as the copay (i.e. $20)
Value: This is the goal! Basically patient outcome relative to the cost, quality + service / cost
Drivers of high health care costs in US
Drivers of high costs (Mnemonic: DILF)
Demographics
Aging population
Health disparities contribute to higher costs
Insufficient prevention and coordination of care
Inadequate attention to social determinants of health
Poor care coordination can lead to unnecessary services and costs
High spending at the end of life
Laws and regulations
Too few regulations can lead to monopolies and price-gouging
Too many regulations can lead to increased costs passed on to the consumer
Legal environment promotes defensive medicine, leading to overtesting and overtreatment
Fee for service third party insurance payment
Moral hazard - if insurance pays for much of health costs, patients may be less motivated to save resources
Promotes quantity over quality of care
Supply and demand → providers are able to negotiate high reimbursement rates
High administrative costs in a complex, multi-payer system
Promotes biomedical advances which can raise costs
Consequences of high healthcare costs in US
Growth in government spending → higher taxes, less money available for other priorities (i.e. education)
Growth in costs to employers who provide health insurance → less competitive with rest of world, lower profits, lower wage increases, fewer full-time hires
Unaffordability of needed care → poor health outcomes
Diverse impact on providers
High health costs can raise provider income
High input costs can reduce provider income
High cost providers may be excluded from some insurance plans
Cost-reduction efforts impact provider practice and satisfaction
Components of high quality healthcare
STEEEP
Safe Timely Effective Efficient Equitable Patient-centered
Leading causes of death in US
the 5 leading causes of death in 2010 were diseases of the heart, cancer, chronic lower respiratory diseases, cerebrovascular disease (stroke), and unintentional injuries (1). Among persons aged <80 years, these 5 diseases represented 66% of all deaths.
INTERHEART study
INTERHEART study, showed that over 90% of the proportion of risk for an initial myocardial infarction is collectively attributable to nine measured and potentially modifiable risk factors: cigarette smoking, diabetes, raised ApoB/Apo A1 ratio, hypertension, abdominal obesity, psychosocial factors, daily consumption of fruits and vegetables, regular alcohol consumption, and regular physical activity.
AHA “Life’s Simple 7”
4 health behaviors (smoking, diet, physical activity, and body weight) with 3 health factors (plasma glucose, cholesterol, and blood pressure) as their metrics and assesses adherence as poor, intermediate, or ideal by distinct definitions
Patient safety medical error adverse event near miss hazardous conditions
Patient Safety: the prevention of harm to patients and the freedom from accidental or preventable injuries produced by medical care
Medical Error: failure of a planned action to be completed as intended (error of execution) or the use of a wrong plan to achieve an aim (error of planning)
Adverse Event: an injury caused by medical management (not the disease process) that led to a prolonged hospital stay or disability at discharge.
Near Miss: an unplanned event that did not result in injury, illness or damage – but had the potential to do so. Almost – but did not reach the patient.
Hazardous Conditions: A circumstance, agent, or action with the potential to cause harm.
Blunt end
Sharp End
Swiss cheese model
Gibson-Haddon safety in principles:
shift focus from behavioral psychology to engineering and epidemiology
The Sharp and Blunt Ends of Care
Blunt End:
Systems and Environment which define work setting
Systems Build Error into the process
Sharp End:
Front-line on which we work and practice
Practitioners operate at the moment the error has an impact.
Swiss Cheese Model
· There are gaps in our current process
· This means that in spite of the full compliance with prevailing standards, an adverse event could/has occurred.
· Possible examples of “holes” in the process
o Poor communication
o Key policies/procedures are inadequate (not up to par)
o Teamwork failures
o Personal failure (individual team member responsibility)
Major dietary guidelines 2015-2020
Limit saturated fats and trans fats, added sugars, and sodium
a. Consume <10% of calories/d from added sugars
b. Consume <10% of calories/d from saturated fats
c. Consume <2,300 mg/d of sodium (* 2,300 mg Na = 5.75 g salt; 1 teaspoon = 5 g salt or 2000 mg Na)
d. If alcohol is consumed, drink in moderation = 1 drink/d for women and up to 2 drinks/d for men
