Flashcards in Public Health Deck (68)
Donabedian framework for health service evaluation
Structure - what is there (buildings, staff, equipment) - e.g. number of ICU beds, no. of vasc surgeons per 1000 popn etc
Process - what is done e.g. no. of pts seen in A&E, number of operations performed etc
Outcome - classification of health outcomes: mortality, morbidity, quality of life/PROMs, patient satisfaction
Define evaluation of health services
Assessment of whether a service achieves its objectives
What are Maxwell's 6 Dimensions of Quality?
(3E's and 3A's)
Effectiveness - does intervention/service produce effect
Efficiency - is output maximised for given input
Equity - pts being treated fairly?
Acceptability - how acceptable is service offered to people needing it?
Accessibility - is service provided? Geog access, costs for pts, info available etc
Appropriateness (relevance) - right treatment being given to right people at right time?
3 domains of public health?
Health improvement (e.g. inequalities, education, housing, employment, lifestyles etc)
Health protection (e.g. infectious disease, chemicals and poisons, radiation, emergency response etc)
Improving services (e.g. clinical effectiveness, efficiency, service planning, audits etc)
Difference between equality and equity?
Equity - giving everyone what they need to be successful
Equality - treating everyone the same
What influences health inequalities?
Place of Residence (rural, urban, etc.)
Race or ethnicity
Social capital or resources
What is horizontal equity?
“Equal treatment for equal need” - e.g. all people with pneumonia deserve equal treatment
What is vertical equity?
Unequal treatment for unequal need. E.g. areas with poorer health may need higher expenditure on health services.
What is a cohort study?
Longitudinal study in similar groups but with different risk factors/treatments.
Follows up over time
Advantages of a cohort study?
Can follow up rare exposure
Allows to identify risk factors
Data on confounders collected prospectively
Disadvantages of a cohort study?
Large sample size required
Impractical for rare diseases
People drop out
What is a case control study?
Observational study looking at cause of a disease.
Compares similar participants with disease and controls without
Looks retrospectively for exposure/cause
Advantages of case control study?
Good for rare outcomes
Disadvantage of a case control study?
Difficult finding appropriately matched controls
Prone to selection and information bias
What is a cross sectional study?
Observational study collecting data from a population and a specific point in time
A snapshot of a group
Advantages of a cross sectional study?
Large sample size
Provides data on prevalence of risk factors and disease
Quick to carry out
Repeated studies show changes over time
Disadvantages of a cross sectional study?
Risk of reverse causality – which came first?
Less likely to include those who recover quickly or short recovery
Not useful for rare outcomes
What is a randomised control trial?
Similar participants are randomly assigned to an intervention or control group to study effect of intervention
What are the advantages of an RCT?
Low risk of bias and confounding
What are the disadvantages of an RCT?
High drop out rate, little incentive to stay in control arm
Prior knowledge required
Time consuming and expensive
What is incidence?
Number of new cases in a population during a specific time period
What is prevalence?
Number of existing cases at a specific point in time.
What is sensitivity?
% correctly identified with the disease (may cause false positives)
What is specificity?
% correctly identified as disease free (may miss people who do have the disease)
Positive predictive value
% of those with a positive test that actually have the disease
Negative predictive value
% of those with a negative test who are actually disease free
What is the criteria for screening a disease?
Natural history of disease needs to be understood (e.g. detectable risk factors, disease marker)
Simple, safe, precise and validated test
Acceptable to the population
Effective treatment from early detection with better outcomes than late detection
Policy of who should receive treatment
Interpreting association between exposure and outcome - 5 things it can be due to?
Bias (systematic differences between comparison groups), chance (poss random error), confounding, reverse causality (outcome results in exposure), true association.
What is bias?
systematic error that results in a deviation from the true effect of an exposure on an outcome