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Flashcards in Principles and Philosophy Deck (39)
1

3 goals of Evidence Infromed Practice

the best care
based on the best available evidence
for the good of the patient

2

4 Pillars of EIP

-critical mass of high quality - research evidence trumps authority or experience
-Clinical research can help predict the probability of a particular clinical outcome and the average response
-research focused on patient centered outcomes trumps bench science or research on biological changes in patience
-research evidence must be interpreted thru the lens of experience and integrated with patient preference

3

5 A's of EIP

Ask
Acquire/Access
Appraise
Apply
Self Asses

4

Hippocrates

4th centruy BC
father of medicine
separted religion from medicine
believed medicine was a calling and treated all people equal
not to differentiate by class or riches

5

Galen

1st to document details of his surgeries and treatments
forwarded the humours theory of hippocrates (black bile, yellow bile, blood and phlegm)

6

Dark ages of Medicine

same time as the fall of the Roman Empire
-self treatment was advocated with books explaining process
-religion began to return to healing as the driving force resulting in exhaltation of saints and Miracle Healers

7

St Rouche

plague

8

St Dymphna

mental illness

9

Phillip von Hohenheim

father of modern toxicology

10

Andreas Versalius

1st to significantly counter and disagree with Galens treatises
authored the Fabric of the Human Body...first major anatomy textbook

11

The Barber Pole

red is blood (letting) white is bandages, and the blue is for veins

12

William Hervey

accurately described blood flow and the hearts role
brought an end to the 4 humours theory in the 1600's

13

Jenner

created small pox vaccine from cow pox, this was the 1st vaccine

14

William Thomas Green Morton

first to use Ester as an anesthetic

15

Anestetics

credited with making surgery a survivable experience
heralded the age of surgery as a modern concept

16

James Lind

nutritional cures (Vitamin C for scurvy)

17

Rene Laennec

created the stethescope

18

Robert Koch

discovered anthrax and Tuberculosis microorganisms
Koch's postulate

19

Kochs Postulate

-the causative agent must be present in every case of the disease and must not be present in healthy animals
-the pathagen must be isolated from the diseased host animal and must be grown in pure culture
-the same disease must be produced when microbes from the pure culture are inoculated into healthy, susceptible animals
-the same pathagen must be recoverable once again from this artificially infected animal and must be able to be grown in pure culture

20

Louis Pasteur

began to articulate the germ theory

21

Wilhelm Conrad Roentgen

used Crooke's tube to create the 1st x ray

22

Gerhard Domagk

inventor of sulfa drugs, the first anitbiotics
followed shortly after was the discovery of pnnicillin

23

Health Insurrance

financing relies on resource pooling
-process of collecting small amounts of money from many to redisribute those resources to the sick populations to cover costs of their illnesses

24

"The Bet" of health insurrance (8)

individuals gett ill at a reasonably predictable rate
the ilnneses populations suffer can be reasonably predicted
rational customers do not want to get sick
resultant expenses can be predicted
cost administering can be predicted
the profit of the system can be estimated
the revenue needed to offset the cost, related to the support structure can be prosectively calculated
revenue from all can be pooled to cover costs of the few

25

Cost of Health Care

$2,809 Billion per year
$8,952 per capita
17.9% of GDP

26

The percentage of US population not insured at all

15.4%

27

Reasons for not being insured

Cost of insurance and recently loosing employment

28

Year of first group health insurance plan

1847

29

Year of Incorperation of Blue Cross and Blue Shield

1932

30

Unions in the 40s and 50s

to drive employment increase unions used health insurance as "fringe benefits"

31

Major Governemtn insurance Plans

Medicare
Medicaid
Tricare
Veterans Administration

32

Primary Elements of Health Care Financing

Cost
Quality
Access

33

Cost (managed care)

compensation lower; all products and technologies purchased at substantial discount due to volume and purchase power

34

Quality (managed care)

standardized practices using evidence and procedural requirements augmented with substantial peer and case oversight, review and control

35

Access (managed care)

patients and physicians practice in pre-established locations and facilities that have control over technology, equipment and theraputic options

36

Types of Managed Care Structures

Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Point-of-Service Organization (POS)

37

Consequences of Managed Care

Patient autonomy is reduced- care is provided through a pre-chosen network or organization
Physician Autonomy is reduced - strict case management, centralized review of the appropriateness of provider practices
Selective Contracting - payers negotiate prices and contract selectively with local providers
Patients experience "Gatekeepers" - must see primary physician who need to prescribe any specialty services
Provider compensation is controlled and often reduced

38

Potential Problems of Managed Care

Dumping
Creaming
Skimping
Lower Quality

39

Medicare

established in 1965
to ensure that insurance was available to retired folks