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Flashcards in Objectives Deck (119):
1

Where are cohort and case-control studies in the hierarchy of evidence?

Best --> Worst
Meta-analysis
Systemic reviews
Critically appraised sources
RCTs
Cohort
Case control
Case reports
Expert opinion

2

What are the types of cohort studies?

Prospective (study starts at the exposure)
Retrospective (study starts after disease progression)
Ambidirectional (study starts at the beginning of the disease after exposure)

3

What are the types of cohorts?

Closed
Fixed
Open

4

What is a closed cohort?

Group followed from start tp pre-defined time end
People cannot enter or leave

5

What is a fixed cohort?

When follow-up time is same for all group members

6

What is an open cohort?

People can enter or leave cohort over chosen time-frame

7

What is cohort exposure?

Can vary based on levels/doses
Can also select non-exposed group separately, but must be as equivalent to exposed as possible

8

What are cohort outcomes?

ECHO

9

What does ECHO stand for?

Economic (Direct and indirect costs)
Clinical (A1c, asthma control, BP)
Humanistic outcomes (QoL, satisfaction w/care)

10

What is a case-control study?

Retrospective
Both cases and controls look back at the exposed and unexposed groups

11

In a case-control study, what results are we looking for?

Physical
Pathological

12

In a case-control study, why is accuracy important?

Do not want to include false positives
Be as restrictive as possible

13

In a case-control study, where does study information come from?

Hospital records
Clinic patient rosters
Death certificates
Cancer registries
Birth registries

14

In a case-control study, what are the types of cases?

Incident cases
Prevalent cases

15

What are incident cases?

New cases
If interested in causes of disease

16

What are prevalent cases?

Old cases
If wanting to know about factors affecting duration

17

In a case-control study, what are controls?

Sample of population that produced cases (study base)

18

What is a good control?

Members of the controls would be a case if they developed the condition

19

What are sources of controls?

Population
Hospital/clinic
Friend/spouse/relative

20

What should the ratio of control to cases be?

1:1 - 1:4

21

What are the ways to analyze cohort studies?

Incidence rate
Risk ratio
Risk difference
Odds ratio

22

What is an incidence rate?

Rate of incidence in both exposed and unexposed groups

23

What is a risk ratio?

Ratio of incidence rates in both the exposed and unexposed groups (a/a+b)/(c/c+d)

24

What does a risk ratio of 1 mean?

No difference

25

What does a risk ratio > 1 mean?

Increased risk

26

What does a risk ratio of < 1 mean?

Decreased risk

27

What is risk difference?

Exposed minus the unexposed rates

28

What is an odds ratio?

Represents the odds that an outcome will occur given a particular exposure compared to the odds of the outcome occurring (a/b)/(c/d)

29

What is an experiment?

Series of observations made under conditions controlled by scientists

30

What is a randomized experiment?

Experiment in which units assigned to receive treatment by random process

31

What is an observational study?

Simply observes size and direction of relationship among variables

32

What is random sampling?

Makes a sample of subjects similar to a population

33

What is a random assignment?

Makes sample of subjects similar to each other

34

What are institutional review boards (IRBs)?

Required for institutions who experiment on humans
Reviews study protocol to ensure Belmont report adhered to

35

What is a type I error?

Finding association when there is not
False positive

36

What is a type II error?

Finding an association when there is
False negative

37

What is an alpha error?

Type I error
Same as p-value
Usually findings < 0.05 are significant

38

What is a beta error?

Type II error

39

How is power calculated?

1-beta
Usually set at 20% (80% power)

40

What is representative sampling?

Sample that looks like population

41

What are types of representative samples?

Random
Stratified random

42

What is random sampling?

Potential subjects have non-zero chance of being selected
Requires access to everyone in population

43

What is stratified random sampling?

Perform random sample of individuals based on a certain set of characteristics

44

What are non-representative sampling?

Most common type of sample, convenience sample

45

What are types of non-representative sampling?

Purposively sample:
Non-random
Only selects people with a defining characteristic

46

What are the types of observational studies?

Cross-sectional
Quasi-experimental

47

What is a cross-sectional study?

Gather info at 1 point in time (cross-section)
Descriptive
Can measure prevalence well
Associations b/n DV and IV

48

Which observational study can identify causal relationships?

Quasi-experimental

49

What is a quasi-experimental study?

Treatment controlled by researcher
Subjects not randomly assigned to treatment

50

Which observational study has high internal validity?

Quasi-experimental

51

What do quasi-experimental studies need to infer causation?

More data than RCTs
More assumptions in analysis to infer causation

52

What is bivariate analyses?

Measures association between 2 variables of interest

53

What is multivariate analyses?

Measures association between a DV and IVs

54

What is the most common type of statistical analyses?

Paramteric

55

What are the most common types of parametric statistics?

Mean
SD
Correlation
T-test
ANOVA
Linear regression

56

What assumptions are made in parametric statistics?

Variable is quantitative
Linear relationship b/n DVs and IVs
Normality of error distribution

57

What type of statistics has a DV that is normally distributed?

Parametric statistics

58

What are types of non-parametric statistics?

Chi-squared
Fisher's exact
Kruskal Wallis
Wilcoxon Mann Whitney
Spearman
Friedman
Logistic regression

59

What is nominal data?

Used for labeling variables, without any quantitative data (nominal sounds like name)

60

What are examples of nominal data?

Color
Sex
Location

61

What is dichotomous data?

Data with only 2 categories
Yes/no
Male/female

62

What is ordinal data?

The order of the data is important, but the difference between the values is not

63

What are examples of ordinal data?

How do you feel? (Okay, happy, very happy)

64

What is interval data?

Numeric scales in which we know the order and exact difference between the values

65

What is an example of interval data?

Temperature

66

What is ratio data?

Tells us about the order, the exact value between units, AND has an absolute zero

67

What are examples of ratio data?

Ht
Wt

68

What are the 3 pieces of cost determinants?

Identification
Measurement
Valuation

69

What are types of hospital costing?

Micro-costing
Case-mix group (accounts for LOS)
Disease specific per diem (daily cost)
Per diem (mean daily cost for all patients)

70

What is the most precise type of hospital costing?

Micro-costing

71

What is the least precise type of hospital costing?

Per diem

72

What are the tangible costs of pharmacoeconomic analyses?

Direct medical costs
Direct non-medical costs
Indirect costs

73

What are direct medical costs and benefits?

Medications
Medication monitoring
Medication administration
Patient counseling and consultations
Diagnostic tests
Hospitalizations
Clinic visits
ED visits
Home medical visits
Ambulance services
Nursing services

74

What are direct non-medical costs?

Travel costs to receive health care
Nonmedical assistance related to condition
Hotel stays for patient or family for out-of-town care
Child care services for children of patients

75

What are indirect costs and benefits?

Lost productivity for patient
Lost productivity for unpaid caregiver
Lost productivity because of premature mortality

76

What are intangible costs and benefits?

Unquantifiable costs and benefits
Improved health after treatment
Reduced pain
Pain and suffering associated with treatment

77

What are short-term tracking of costs and outcomes?

Hospital to d/c

78

What are medium-term tracking of costs and outcomes?

Payer
1-5 years

79

What are long-term tracking of costs and outcomes?

Patients
Life-time

80

What are the outcomes of CMA?

Assumed to be equivalent

81

What are the outcomes of CEA?

Natural units (life years saved)

82

What are the outcomes of CBA?

$

83

What are the outcomes of CUA?

QALY

84

What are the questions answered by CBA?

Which programs should be implemented
How much or what combination of outputs should be produced

85

What are the methods of measuring CBA?

Human capital
Willingness to pay

86

What is the simplest evaluation?

CMA

87

How is CMA used?

Compares 2+ alternative treatments that produce equivalent outcomes
Choose option with lowest cost

88

What is net benefit?

Total benefit - total costs

89

What benefit:cost ratio is preferred?

> 1

90

What does ICER stand for?

Incremental cost-effectiveness ratio

91

When are interventions said to be cost effective?

Less expensive AND more effective
Less expensive AND at least as effective
More expensive AND more effective

92

When is an ICER positive?

New tx more expensive AND more effective
New tx less costly AND less effective
Want smaller ICER

93

When is an ICER negative?

New tx less costly AND more effective
New tx more costly AND less effective

94

When is an ICER dominant?

Less costly AND more effective

95

When is an ICER dominated?

More costly AND less effective

96

What is a type of CEA?

CUA

97

What is QALY?

Combination of quantity life gained (mortality)
AND
Quality of the life gained (morbidity)

98

How do we measure quality of life gained?

Scale from 0 (death) - 1 (perfect health)

99

What are the disadvantages of a CUA?

Most difficult
Most time consuming
Most expensive

100

What are the ways to estimate utilities?

Visual analog scale (VAS)
Standard gamble (SG)
Time Trade-Off (TTO)

101

What is the VAS?

Easiest method to directly obtain utilities

102

What is a standard gamble?

Based on utility theory
2 alternatives

103

What is TTO?

Simpler, easier to use then SG
Subject offered 2 alternatives and they get to choose

104

What is a latent variable?

An unobservable phenomenon that takes on a specific value under a set of conditions

105

What are examples of latent variables?

Trust in physicians
QoL
Health literacy levels

106

What is reliability?

Proportion of variance attributable to the true score of the latent variable

107

What is a true score?

A scale developed to measure a latent variable is intended to estimate its actual magnitude at the time and place of measurement for each subject

108

What does reliability measure?

Same result

109

What are the types of validity?

Content validity
Criterion-related validity
Construct validity

110

What question does validity answer?

Is the latent variable the underlying cause of item covariation

111

What is content validity?

Extent to which a set of items reflects content domain

112

When does a scale have content validity?

When items are a randomly chosen subset of the universe of appropriate items

113

What is criterion-related validity?

Scale related to a gold standard
Also called predictive validity

114

What does construct validity measure?

Measures theoretical relationship of a variable to other variables

115

What are the two ways to measure self-reported HRQoL?

Generic
Disease specific

116

What are advantages of generic HRQoL?

Broadly applicable
Summarizes a range of concepts
May detect unanticipated effects

117

What are disadvantages of generic HRQoL?

May not be responsive to changes in health
May not be relevant for specific populations
Results may be difficult to interpret

118

What are advantages of disease specific HRQoL?

More relevant for specific populations
More responsive to changes in health

119

What are disadvantages of disease specific HRQoL?

Cannot compare across populations
Less likely to detect unanticipated effects