saint HCM530 all discussions [ spring 2014 ]

Module 1 Discussion

The discussion question for this module is a series of questions related to a case study found in Chapter 1 of the text. Please answer all three questions (found below) in your initial response.

Chapter 1 (pp 7-15): CASE STUDY—GROUP HEALTH EAST (GHE)

• 100,000-member managed care organization
• Mixed model
• 55-year-old administrator (Mr. Jones)
• Two large multi-specialty groups, each with a separate clinic
• 500 individual MDs in community
• Affiliated with two major hospitals in Boston
• Each clinic maintains a functional design
• Two divisions (support services and clinical services)
• Considering moving to a “matrix model”

Initial Discussion Questions:

1. What are the advantages and disadvantages of a matrix model for GHE in terms of direct and indirect costs, as well as benefits such as improved coordination?
2. How many product lines should the organization identify?
3. How should the organization determine which product lines ought to maintain separate identities as part of the matrix design?

Be sure in your initial response you support your findings and post with at least two quality, primary sources, which may include you textbook. Cite and reference your sources. (write 5-6 sentence summaries for each question).

Module 2 Discussion

The discussion question for this module is a series of questions related to a case study found in Chapter 3 of the text. Please answer all three questions (found below) in your initial response.

Chapter 3: CASE STUDY (3.2)—Breast Cancer Screening
In Case Study 3.2 in the text, Pisano and colleagues (2006) compared the performance of digital to film mammography for breast cancer screening. Now assume that the sensitivity and specificity of digital mammography is 85% and 95% respectively, the sensitivity and specificity of film mammography is 55% and 85% respectively, and that 0.03% of women below the age of 50 have breast cancer, and 12% of symptomatic women have breast cancer.

Initial Discussion Questions:

1. How successful is film mammography in identifying women with breast cancer, or ruling out the disease in women without breast cancer?
2. Are there any recent advances (previous 5 years) that could improve the success rates? If so, please explain what they are.

Be sure in your initial response you support your findings and post with at least two quality, primary sources, which may include you textbook. Cite and reference your sources. (write 5-6 sentence summaries for each question).

Module 3 Discussion

The discussion question for this module is a series of questions related to a case study found in Chapter 3 of the text. Please answer all three questions (found below) in your initial response.

Chapter 5: CASE STUDY (5.3)—Inpatient Quality of Care Indicators for Bluegrass Hospital
Suppose that the Kentucky Hospital Association (KHA) decided to provide a service to its member hospitals by using the inpatient claims database to calculate inpatient quality of care indicators for each hospital. They provide a report to each hospital comparing them to national norms. Table 5.5 presents some of these indicators for Bluegrass Hospital, a fictional 200-bed hospital located in Central Kentucky. Upon receiving this report, Bluegrass Hospital organizes a quality improvement (QI) team to evaluate and develop recommendations.

Initial Discussion Questions:

1. From an evaluation of the report card only, Bluegrass Hospital would seem to be deficient in which areas? Why?
2. Since the report is based on an evaluation of administrative data, what should the first course of action be? Why?

Research an inpatient quality of care indicator and provide a 5-6 sentence summary of an article from peer reviewed literature that describes how performance on that indicator can be improved upon.

Module 4 Discussion

Clinical, research and managerial epidemiologists deal in risk. Risk is the chance that a person may or may not develop the condition, with or without exposure, in a defined time period. There is more than one type of risk.

Type of Risk	Absolute risk(incidence, prevalence)	Relative risk (RR)(Odds Ratio)	Attributable risk/fraction
Risk Objective	To determine the rates of disease by person, place and time	To identify the risk factors for the disease	To develop approaches for disease prevention
Example	Birth/death rates are absolute!	What are the odds?	Increase/decrease in incidence/proportion?

1. What do we know about the absolute, relative risk and attributable risk of smoking and lung cancer?
2. How may this knowledge help in private and public health epidemiology?

Be sure in your initial response to provide at least two examples from peer reviewed literature that expound upon this relationship (write 5-6 sentence summaries for each article).

Module 5 Discussion

The cost effectiveness analysis (CEA) is one type of a benefit analysis tool used in managerial epidemiology. Others include cost-utility, cost-effectiveness, cost-consequence, and cost of illness. Since medical quality and health services have a high individual perception regarding value, different stakeholders will have different perspectives when performing and interpreting a CEA. Different decision makers, i.e., physicians, administrators, employers, payers, government and other public and private officials all have varying perspectives. Therefore, it is the common perspective that is generally most useful when making comparisons among the various interpretations of the CEA or other cost/benefit analysis results and outcomes.

1. Where does the CEA fit into public health and clinical epidemiological research, as well as, health services research?
2. What are some examples and characteristics of medical cost and effectiveness measures?

Be sure in your initial response to provide at least two examples from peer reviewed literature that further clarify or illustrate your response (write 5-6 sentence summaries for each article).

Module 6 Discussion

How research is designed is important to its validity. In research, and particularly government funded research, the Institutional Review Board is the authority on requirements for research design.

DHHS, Institutional Review Board Guidebook. Chapter 4: Considerations of Research Design
A. Introduction	F. Case-Control Studies
B. Observation	G. Prospective Studies
C. Record Reviews and Historical Studies	H. Clinical Trials
D. Surveys, Questionnaires, and Interviews	I. Identification and Recruitment of Subjects
E. Epidemiologic Studies	J. Assignment of Subjects to Experimental and Control Groups

Four common research designs used in epidemiological studies are cohort, case control, longitudinal, and cross-sectional studies. However, there are also prospective and retrospective, quantitative, qualitative and quasi (mixed) research designs. Data is what drives medical research and its design. Medical research drives scientific findings that ultimately result in improving human health. All of the various research study designs that fall into either descriptive or analytical epidemiology.

All research studies fall into either descriptive or analytical epidemiology.

1. What are those study designs and how are they defined?
2. What are the strengths and weaknesses of each of the designs you have defined?

Be sure in your initial response to provide at least two examples from peer reviewed literature that further clarify or illustrate your response (write 5-6 sentence summaries for each article).

Module 7 Discussion

In last week’s discussion, we looked at types of research designs. This week, we will look at requirements of designs using real people, i.e., the clinical trials.



Office for Human Research Protections (OHRP)

1. There are two types of clinical studies, i.e., clinical trials and observational studies. How do they differ and provide examples of each?
2. Who can participate in a clinical study and what is the process to protect them from harm?

Be sure in your initial response to provide at least two examples from peer reviewed literature that helps to support your position (write 5-6 sentence summaries for each article).

Module 8 Discussion

Disease may be classified as acute, subacute or chronic. It may be emerging or reemerging. Why is it a challenge in defining diseases as either totally chronic or totally infectious (acute) in nature? What are examples of emerging and reemerging diseases? Would HIV be considered an emerging or reemerging?

Be sure in your initial response to provide at least two examples from peer reviewed literature that helps to support your position (write 5-6 sentence summaries for each article).