Epidemiology and the Delivery of Health Care Services

Transcription

1 Epidemiology and the Delivery of Health Care Services Methods and Applications Second Edition

2 Epidemiology and the Delivery of Health Care Services Methods and Applications Second Edition Edited by Denise M. Oleske Rush University Chicago, Illinois KLUWER ACADEMIC PUBLISHERS NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW

3 ebook ISBN: X Print ISBN: Kluwer Academic Publishers New York, Boston, Dordrecht, London, Moscow Print 2001 Kluwer Academic/Plenum Publishers New York All rights reserved No part of this ebook may be reproduced or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, without written consent from the Publisher Created in the United States of America Visit Kluwer Online at: and Kluwer's ebookstore at:

4 Contributors Dolores G. Clement Department of Health Administration School of Allied Health Professions Virginia Commonwealth University Richmond, Virginia Gerald L. Glandon Department of Health Services Administration University of Alabama at Birmingham Birmingham, Alabama Jack Goldberg Epidemiology/Biostatistics Division School of Public Health University of Illinois at Chicago Chicago, Illinois Marcia B. Hargreaves Quality Improvement and Volunteer Services Rush-Presbyterian-St. Luke s Medical Center and Department of Health Systems Management Rush University Chicago, Illinois Ronald C. Hershow Department of Epidemiology School of Public Health University of Illinois at Chicago Chicago, Illinois Frances J. Jaeger University of Illinois at Chicago Perinatal Center Chicago, Illinois v

5 vi Contributors Sana Loue Department of Epidemiology and Biostatistics School of Medicine Case Western Reserve University Cleveland, Ohio Karl A. Matuszewski Clinical Knowledge Service University HealthSystem Consortium Clinical Practice Advancement Center Oak Brook, Illinois and Department of Health Systems Management Rush University Chicago, Illinois Helen Jo Neikirk Clinical Information Management University HealthSystem Consortium Oak Brook, Illinois Denise M. Oleske Departments of Health Systems Management and Preventive Medicine Rush University Chicago, Illinois Marcia Phillips Department of Health Systems Management Rush University Chicago, Illinois Iris R. Shannon Department of Health Systems Management Rush University Chicago, Illinois Bailus Walker, Jr. Environmental and Occupational Medicine Program College of Medicine Howard University Washington, DC 20059

6 Contributors vii Thomas T. H. Wan Department of Health Administration School of Allied Health Professions Virginia Commonwealth University Richmond, Virginia Diane R. Weber Quality Services University HealthSystem Consortium Oak Brook, Illinois 60523

7 Preface In the previous edition of this book, the predominant theme was applying epidemiology to assist managers in dealing with an environment in which the structure of health care financing was rapidly changing to managed care and in which there was increasing competition among health care providers. While these phenomena continue to exist, new challenges have emerged, and in particular the explosion of information technology has given way to a global society and decision making that is increasingly shared with consumers because of their access to the same sets of data. Thus, the questions with which health care managers are confronted on a daily basis are now exceedingly more complex: (1) How can a population be defined considering that both exposures and diseases originating in one corner of the globe can rapidly become a threat to any nation s security? (2) Where do influences on a population begin and end? (3) How can we protect and promote health in that population or any population if privacy is preeminent? This edition brings in this editor s view of the increasing need for health care managers, be they in private or public settings, to use epidemiological concepts and methods. The challenges posed by health care delivery in the 21st century are immense, ranging from redefining life and health given the advances in genetic technology, global environmental changes, and multinational simultaneous increases in poverty and longevity, to economic decisions regarding technology and service levels that fewer and fewer can afford. Epidemiology, as the language of science, is the essential tool in health care management decision making, be it at the point of direct service or at the level of deciding national priorities in a limited health care budget. This edition presents core epidemiological principles and their applications in the first six chapters. The next five chapters illustrate how epidemiology is used in management planning, decision making, and practice in specialty areas (health care quality management, transmissible disease control, genetic health services, technology assessment, and health care services for environmentally provoked health problems). The last set of chapters demonstrates how epidemiology at the macrolevel interfaces with other disciplines (economics, policy, and ethics) when health care management faces initiatives at the cusp of public and private sector interests. Prior or current enrollment in coursework in biostatistics and in health care organizations at the graduate level are highly recommended to better appreciate the material presented herein. Throughout the book, the need to use the scientific method in management decision making is emphasized. Specific content is presented (e.g., the scientific method, assessment of causality, study designs, survey form construction, etc.) such that this book can be used to teach principles of research methods to prepare students for their theses or other capstone projects in health care management. ix

8 x Preface As in the last edition, all chapters are written by individuals who apply epidemiological thinking and methods in their current positions. Additionally, since most chapter authors have had international health care experience, the topics presented in these chapters analyze the top priorities and concerns relative to health care globally. Following each chapter, the reader is challenged with case studies relevant to the theme of the chapter that require epidemiological concepts and techniques for their solution. Most of the cases are new and all are real-life or based on real-life situations that the reader is likely to encounter as a health care manager. Some of the cases have suggested answers provided in the end of the volume. It must be emphasized that these are suggested answers; different situations, depending on the context, resources, and time, may require different approaches. Some of the cases have questions without answers; this is intended so that users of the volume can develop their own creative solutions using epidemiological principles and methods. You are encouraged to use the Websites for Health Care Managers Thinking Epidemiologically in devising your own solutions. Enjoy reading (and using) this new edition! Chicago, Illinois Denise M. Oleske, Ph.D., F.A.C.E.

9 Contents Fundamentals Chapter 1 An Epidemiological Framework for the Delivery of Health Care Services 3 Denise M. Oleske An Epidemiological Model for the Delivery of Health Care Services 3 The Population 4 Population Trends 6 Need for Health Care 6 Utilization of Health Care Services 10 Factors Affecting Health Care Utilization 12 Accessibility of Health Care 13 Availability of Health Care Resources 13 Health of Populations Served 14 Applying Epidemiology in Health Care Management Practice 15 Monitoring Service Population Size 15 Distribution of Health Needs in a Population 16 Understanding the Genesis and Consequences of Health Problems 18 Understanding the Relationship between Health System Characteristics and the Health Status of Populations Served 18 Monitoring Health Care Systems, Organizations, and Program Performance 19 Modifying the Structure and Processes to Respond to Environmental Change 20 Formulation and Evaluation of Public Policy Affecting the Delivery of Health Care Services 20 Summary Chapter 2 Measurement Issues in the Use of Epidemiological Data Denise M. Oleske Introduction Methods of Measurement xi

10 xii Contents Validity and Reliability of a Measure 31 Validity 33 Reliability 36 Logistics of Measurement 37 Classification of Health 38 Disease 38 Injuries 40 Functioning and Disability 40 Mental and Behavioral Disorders 41 Quality of Life 41 Other Health Measures 42 Classification of Health Services 42 Classifying Organizational Units 42 Classifying Procedures 43 Control of Measurement Error 43 Sources of Data 44 Summary Chapter 3 Descriptive Epidemiological Measures Denise M. Oleske 51 Measuring the Frequency of Health Events in Populations 51 Incidence Rate 51 Prevalence Rate 53 Sources of Information for Incidence Rate Measures 54 Sources of Information on Prevalence 55 Format of Descriptive Epidemiological Measures 57 Specific Rates 58 Summary Rates 58 Ratio Measures 64 Summary Chapter 4 Assessing Causality: Foundations for Population-Based Health Care Managerial Decision Making 75 Thomas T. H. Wan Introduction Scientific Inquiry Characteristics of Scientific Inquiry Logic of Scientific Inquiry

11 Contents Stages in Scientific Inquiry Identification and Specification of the Study Problem Selection of an Informed Theoretical Framework Quantification of Study Variables Selection of a Study Design Specification of the Analytic Framework: Proposing the Hypothesis and Setting Error Tolerances Selecting a Statistical Test Multilevel Analysis Evaluating Causality Meta-analysis Conclusions xiii Chapter 5 Strategic Planning: An Essential Management Tool for Health Care Organizations and Its Epidemiological Basis Frances J. Jaeger Epidemiological Basis of Strategic Planning Theoretical Basis of Strategic Planning The Strategic Planning Process Step 1. Plan the Planning and Ensure Favorable Conditions for Effective Strategic Planning Step 2. Review the Organization s Mission Statement and Revise It as Necessary to Ensure That It Remains Relevant to the Organization s Future. If No Written Statement of Mission Exists, Develop and Adopt One Step 3. Do a Situational Analysis that Encompasses Assessments of Elements of the Organization s External and Internal Environments as Well as an Evaluation of the Impact of the Organization s Efforts Step 4. Apply an Approach for Defining the Key Issues, Focusing the Attention of the Organization, and Establishing the Framework for the Next Step of Strategy Development Step 5. Generate, Evaluate, and Select Alternative Strategies for Achieving Organizational Goals and Objectives or the Best Alignment of the Organization with the Opportunities in Its Environment Step 6. Carry Out the Implementation Phase of Strategic Planning, Detailing Operational Action Plans and Budgets, Monitoring Impact, and Making Midcourse Adjustments as Necessary Data Resources and Issues Related to Use in Strategic Planning Tools to Facilitate Strategic Planning Applicability of the Strategic Planning Process The Format and Content of the Strategic Plan Conclusions

12 xiv Chapter 6 Evaluating Health Services, Programs, and Systems: An Epidemiological Perspective Dolores G. Clement and Thomas T. H. Wan Dimensions of Health System Evaluation Determine the Population Targeted for Intervention Identify Aspects of Health Care To Be Evaluated The Evaluation Process Planning Implementation Intervention Monitoring and Feedback Conceptual Framework for Specifying Evaluation Criteria Analytical Approaches to Evaluation: An Epidemiological Perspective Study Designs Analyzing Intervention Effects Other Analytic Methods Prospects of Health Services Evaluation Conclusion Contents Specialty Areas Chapter 7 Epidemiology and Health Care Quality Management 157 Diane R. Weber, Helen Jo Neikirk, and Marcia B. Hargreaves Introduction Interrelationship between Health Care Quality Management and Epidemiology Quality Management Defined Organizational Approaches to Quality Management Programmatic Options in Quality Management Quality Planning Performance According to Standards, Guidelines, and Other Management Strategies Performance According to Standards Clinical Practice Guidelines Utilization Management Case Management Risk Management Best Practices Models for Systematic Improvement Plan Do Check Act Model Clinical Value Compass Quality Measurement Process Measures

13 Contents Clinical Outcomes Satisfaction Health Status Data Sources Sampling Levels of Quality Measurement Quality Improvement Tools and Techniques Brainstorming Affinity Diagram Cause-and-Effect Diagram Flowchart Statistical Quality Control Tools Check Sheet Histogram Pareto Chart Scatter Diagram Run Chart and Control Chart Comparison Charts Application of Quality Control Tools Risk Adjustment Conclusion xv Chapter 8 Control of Transmissible Diseases in Health Care Settings Denise M. Oleske and Ronald C. Hershow Introduction Infectious Disease Concepts Managing Disease Outbreaks Managerial Responsibilities in Infection Control Bloodborne Disease Transmission Epidemiology of Hepatitis B Epidemiology of Human Immunodeficiency Virus Infection Bloodborne Disease Control Measures Hazard Communication Airborne Disease Airborne Disease Control Measures Special Considerations in Infectious Disease Control for Specific Health Care Service Settings Inpatient Acute Care Facility Ambulatory Care Home Care Long-Term Care/Skilled Nursing Facility Hospice Behavioral Health Care Settings Conclusion

14 xvi Contents Chapter 9 Genetic Epidemiology: The Basis for a New Health Service Delivery Model Marcia Phillips and Jack Goldberg Introduction Basic Genetic Concepts Mendelian Genetics Exceptions to Mendel s Laws The Human Genome Project Scope and Progress Genetic Mapping Epidemiology and the Human Genome Project International Implications Genetics and Epidemiology Roles of Epidemiology Genetic Techniques and Epidemiology Genetic Epidemiology Studies Health Services Management and Genetic Epidemiology Screening Population-Based Genetic Health Screening Service: Screening for Phenylketonuria, a Model Future of Genetic Screening Programs Economic and Health Impact of Genetic Testing Information Systems Support for Genetic Health Services The Ethical Challenges of Genetics Conclusion Chapter 10 Technology Assessment Karl A. Matuszewski Defining Technology Assessment and Its Function Categories of Technology Devices Procedures Pharmaceuticals Technology Life Cycle Targeting Technologies for Assessment High Utilization High Potential for Harm High Cost How Is Technology Assessment Performed?

15 Contents Literature Review and Synthesis Consensus Panels Decision Criteria Meta-analyses Outcomes Assessment Randomized Clinical Trials Other Methods Who Does Technology Assessment? US Food and Drug Administration Agency for Healthcare Research and Quality American College of Physicians Blue Cross and Blue Shield Association ECRI Center for Practice and Technology Assessment (CPTA) University Health System Consortium Other Assessment Centers International Efforts Problems in Performing Technology Assessment Lack of Evidence Lack of Agreement on How to Perform the Assessment Inconsistent Evidence Legal Interference Breadth of Topics New Information Imperfect Use of Technology Future of Technology Assessment Summary xvii Chapter 11 Health Risks from the Environment: Challenges to Health Service Delivery Bailus Walker, Jr. Introduction Problems in Environmental Health Gene Environment Interaction Impact of the Environment on the Reproductive System Impact of the Environment on the Immune System Impact of the Environment on the Nervous System Impact of the Environment on the Respiratory System Environmental Terrorism Climate Changes, Cataclysmic Events, and Other Disasters Environmental Equity Global Environmental Health Recognition and Assessment of Environmentally Related Disease Risk Assessment

16 xviii Health Services for Environmentally Provoked Diseases Primary Prevention Secondary Prevention Tertiary Prevention Summary and Conclusion Contents Spanning Topics Chapter 12 Epidemiology and the Public Policy Process Iris R. Shannon A Contextual Framework for the Relationship between Public Policy and Epidemiology: Public Health Public Health National Health Objectives Public Policy: An Interactive Process The Interrelationship between Epidemiology and Public Policy Application of Epidemiology in the Policy Process US Department of Health and Human Services Initiative to Eliminate Disparities in Health Infant Mortality Vaccine-Preventable Diseases Childhood Hepatitis B Infections and Hepatitis B Vaccine Use Summary Chapter 13 The Contribution of Epidemiological Information in Economic Decision Making Gerald L. Glandon Introduction Background: Public Goods Government Provision of Public Goods Health Care and Public Goods Overview of the Definition and Core Elements of Cost Benefit Analysis and Cost-Effectiveness Analysis Cost-Effectiveness Analysis, Epidemiological Data, and Application to Managerial Decision Making Conclusion

17 Contents Chapter 14 Ethics, Epidemiology, and Health Service Delivery Sana Loue Introduction Approaches to Resolving Ethical Dilemmas Principlism Casuistry Communitarianism Feminist Ethics Utilitarianism Principles, Rules, and Guidelines The Nuremberg Code and Declaration of Helsinki The International Covenant on Civil and Political Rights CIOMS and WHO International Guidelines United States Guidelines and Regulations Operationalizing Codes, Guidelines, and Regulations in the Context of Research and Patient Care Informed Consent Confidentiality and Privacy Concerns Conclusions xix Suggested Answers to Selected Case Study Questions 353 Appendix Websites for Health Care Managers Thinking Epidemiologically 373 Glossary 385 Index 395