Flashcards in Book - Quality & Prevention Deck (18)
Components of high quality care?
Access to care, adequate scientific knowledge, competent health care providers, separation of financial and clinical decision, and organization of health care institutions to maximize quality
Components: Adequate scientific knowledge?
Need to distinguish between effective and ineffective/harmful care for appropriate standard of care
Components: Separation of financial and clinical decisions?
Physician motivations should not be related to financial considerations (can lead to waste OR inadequate care)
Proposals for improving quality?
Clinical practice guidelines, continuous quality improvement, EMR, financially neutral clinical decision making, measuring practice patterns, pay for performance, pay for reporting, public quality reporting, traditional quality assurance
Proposals: Traditional quality assurance?
Proper licensure, accreditation, peer review (currently, NO requirement of period reexaminations for licensing)
Proposals: Clinical practice guidelines?
Agency for Healthcare Research Quality (AHRQ) gives specific recommendations on how to treat clinical conditions (although some physician/pharma interests may be against this, and recommendations aren't applicable to all)
Proposals: Measuring practice patterns?
Process (types of services delivered), outcome, and structure....get feedback on this information
Proposals: Continuous quality improvement?
Collaborate with interdisciplinary teams to improve institutions (currently only a small part of improvement)
Proposals: EMR (3 benefits)?
1) Offers ways to monitor process/outcome for entire populations 2) Can generate reminder prompts for physicians and patients 3) Can regulated incorrect doses or medications likely to interact
Negative side effects of malpractice?
1) System assumes punishment is reasonable method for improving quality 2) Based on assumption that trial by jury is best method to determine negligence 3) people with lower incomes usually receive smaller awards, so less attractive to file suit
Malpractice reform options? (4)
Tort reform (caps on damages and lawyer fees), alternative dispute resolution (handle shit outside of court), no-fault reform (damages to injured patient regardless of negligence....create incentives for institutions to improve quality of care)
Primary v. Secondary prevention?
Primary: seeks to avert the occurrence of disease or injury. Secondary: Early detection of a disease process and intervention to reverse or retard the condition from progressing
2 examples of primary prevention?
Immunization, taxes on cigarette sales
3 prevention strategies?
Improve standard of living, PH interventions to reduce illness incidence (water purification, tobacco tax), and preventive medical care
Chronic disease prevention - 2 levels?
Individual chronic disease prevention? Issues?
Medical model: identify high-risk individuals and provide them counseling. It's like having blinders on (May target interventions at the wrong individuals)
Population chronic disease prevention?
Reduce disease in the population as a whole through mass education campaigns, labeling of food, etc (this can be done by targeting risk factors)