Instant download Managerial epidemiology for health care organizations (public health/epidemiology a by Education Libraries

Epidemiology for Health Care Organizations (Public Health/Epidemiology and Biostatistics)

Visit to download the full and correct content document: https://ebookmass.com/product/managerial-epidemiology-for-health-care-organization s-public-health-epidemiology-and-biostatistics/

More products digital (pdf, epub, mobi) instant download maybe you interests ...

Nutrition for Health and Health Care 6th Edition, (Ebook PDF)

https://ebookmass.com/product/nutrition-for-health-and-healthcare-6th-edition-ebook-pdf/ (eTextbook PDF) for Biostatistics for the Biological and Health Sciences 2nd Edition

https://ebookmass.com/product/etextbook-pdf-for-biostatisticsfor-the-biological-and-health-sciences-2nd-edition/

Biostatistics for the Biological and Health Sciences 2nd Edition, (Ebook PDF)

https://ebookmass.com/product/biostatistics-for-the-biologicaland-health-sciences-2nd-edition-ebook-pdf/

Nutrition for Health and Health Care 7th Edition Edition Linda Kelly Debruyne

https://ebookmass.com/product/nutrition-for-health-and-healthcare-7th-edition-edition-linda-kelly-debruyne/

India's Public Health Care Delivery: Policies for Universal Health Care 1st Edition Sanjeev Kelkar

https://ebookmass.com/product/indias-public-health-care-deliverypolicies-for-universal-health-care-1st-edition-sanjeev-kelkar/

Health and Health Care Delivery in Canada Third Edition

Valerie D. Thompson

https://ebookmass.com/product/health-and-health-care-delivery-incanada-third-edition-valerie-d-thompson/

Nutrition for Health and Health Care (MindTap Course List) 7th Edition, (Ebook PDF)

https://ebookmass.com/product/nutrition-for-health-and-healthcare-mindtap-course-list-7th-edition-ebook-pdf/

Advanced Biosensors for Health Care Applications

Inamuddin

https://ebookmass.com/product/advanced-biosensors-for-healthcare-applications-inamuddin/

Nutrition for Health and Health Care (MindTap Course List) 7th Edition Linda Kelly Debruyne

https://ebookmass.com/product/nutrition-for-health-and-healthcare-mindtap-course-list-7th-edition-linda-kelly-debruyne/

ListofTables,Figures,andExhibitsxiii

Prefacexxiii

TheAuthorsxxvii

1EpidemiologyinHealthCareAdministration1

Introduction2

PhilosophicalFramework5

FocusandUsesofEpidemiology6

ObservationalEpidemiology•ExperimentalEpidemiology•PreventiveMedicine

HealthCareReform8

TheConceptofPopulationsandCommunities11

ManagingHealthCareforPopulationsandCommunities12

RoleofEpidemiology14

Summary16

StudyQuestions16

2DescriptionofHealth19

Introduction20

HealthandDisease21

Deﬁnitions•InternationalClassiﬁcationofDiseasesandRelatedProblems •HealthStatus

DescriptiveInformation25

PersonVariables•PlaceVariables•Time

OtherDescriptiveVariables41

SourcesofDescriptiveInformation43

VitalStatistics•MedicalRecords

ReportableDiseases47

ManagerialApplications47

Summary52

StudyQuestions52

3MeasurementofHealth55

Introduction56

Measures56

Counts•Rates•Ratios•Proportions

MeasuringMorbidity65

IncidenceRate•PrevalenceRate•PeriodPrevalenceRate MeasuringMortality73

DeathRates•PotentialYearsofLifeLost MeasuringHealth83

SurvivalRate•Health-RelatedQualityofLife

OtherRates85

Summary86

StudyQuestions86

4StudyingtheHealthNeedsofPopulations89

Introduction90

RiskandCausation91

StudyDesigns93

Experimental•ClinicalTrials•Observational•DescriptiveStudies •Cross-SectionalStudies•EcologicalStudies•ProspectiveStudies •RetrospectiveStudies

AssociationofRiskFactorsandHealthandDisease103

MeasuringAssociationinProspectiveStudies104

MeasuringAssociationinRetrospectiveStudies108

ApplicationtoPopulationHealthManagement110

Sampling113

Summary115

StudyQuestions115

5StandardizingPopulationHealthInformation117

Introduction118

Stratiﬁcation120

Matching121

StandardizationofInformation123

DirectMethodofStandardization•IndirectMethodofStandardization RiskAdjustment136

Summary139

StudyQuestions140

6MedicalManagementinPopulationHealthCare149

Introduction150

MedicalManagement151

ClinicalEffectiveness•Validity•ManagerialAspectsofValidity•Reliability •ImpactofTestInformation•ClinicalPracticeAnalysis

ChronicDiseaseManagement169

Summary170

StudyQuestions171

7ManagementofInfectiousEpidemics175

Introduction175

InfectiousDiseaseEpidemiology176

InfectiousEpidemics

HealthCare–AssociatedInfections182

Surveillance186

Summary188

StudyQuestions188

8ReimbursementApproachesandMarketing191

Introduction192

ReimbursementMethods193

CurrentProceduralTerminology•Capitation•Diagnosis-RelatedGroups •OutpatientProspectivePaymentSystem•InpatientRehabilitationFacilityProspective PaymentSystem•SkilledNursingFacilityProspectivePaymentSystem•Home HealthProspectivePaymentSystem•Resource-BasedRelativeValueScale• AccountableCareOrganizations•PayforPerformance

MarketingandPopulationHealth202

Marketing•TheRoleofMarketing•MarketingtheHealthCareSystem MarketResearch204

Sampling•MarketResearchDataAnalysis•PatientSatisfaction•Demand Estimation•ValidityandReliabilityofMarketResearch

Summary214

StudyQuestions215

9PopulationHealthOutcomesandQualityofCare219

Introduction220

AssessingHealthOutcomes220

HealthStatusAssessment225

PatientSatisfactionandPatientExpectationsAssessment227

MonitoringHealthOutcomes231

ManagingwithHealthOutcomes232

UsesofOutcomesAssessment•Benchmarking•BestPracticesandPractice Guidelines•ApplicationofBestPracticeAssessment•RootCauseAnalysis

QualityofHealthCare241

RapidImprovementCycleProcess•StatisticalProcessControl•TheMalcolm BaldrigeNationalQualityProgram

Summary250

StudyQuestions251

10EconomicAnalysisofHealthCareforPopulations253

Introduction254

EconomicEvaluation257

CostAnalysis259

Cost-BeneﬁtAnalysis261

Cost-EffectivenessAnalysis262

Cost-UtilityAnalysis264

Discounting265

SensitivityAnalysis269

BurdenofDiseaseAnalysis269

ExamplesofEconomicAnalysis272

Summary275

StudyQuestions276

11ExpandingHospitalHealthCareServices281

Introduction282

ServiceAreaPopulation283

HospitalCareUtilization284

Discharges287

LengthofHospitalStay289

HospitalDescription292

PaymentSources293

ServiceAreaPopulationHealth296

12Long-TermCare303

Introduction303

PopulationCharacteristics304

WestsideElderlyCare,Inc.308

UtilizationofServices308

Stafﬁng319

13EmergencyDepartmentServices321

Introduction321

EmergencyDepartmentUtilization322

PaymentSources331

TimeAnalysis332

PrimaryDiagnosisatArrival336

PatientDisposition337

14PhysicianPractices341

Introduction342

PopulationCharacteristics342

ResourceUtilization343

TimeSinceLastVisit346

InsuranceCoverage349

ReasonforVisit351

PreventiveCareVisits355

ChronicConditions356

References359

Index375

Tables

LISTOFTABLES,FIGURES,ANDEXHIBITS

2.1Number,PercentDistribution,andRateofInjury-RelatedEmergency DepartmentVisits,byAge,201126

2.2PercentofPersonsLackingHealthInsurance,StateswithState-Based Marketplace,18to64YearsofAge,2010–201627

2.3CancerDeathRates,byAge,UnitedStates,201328

2.4TuberculosisCases,byAge,UnitedStates,201328

2.5Deaths,bySex,UnitedStates,201429

2.6Number,PercentDistribution,andRateofInjury-RelatedEmergency DepartmentVisits,byAgeandSex,201130

2.7EmergencyDepartmentVisits,byRace,UnitedStates,201131

2.8FrequencyofCancerDeaths,byRaceandCancerSite,per100,000 Population,UnitedStates,201331

2.9FrequencyofNewCancerCases,byRaceandCancerSite,per 100,000Population,UnitedStates,201332

2.10ChronicDiseaseRiskFactorsandMaritalStatus,201034

2.11PercentageofUninsuredPersonsUnder65YearsofAgeandPoverty Status,UnitedStates,2005–201634

ListofTables,Figures,andExhibits

2.12PercentageofPersonsLackingHealthInsuranceCoverage, byEducationalStatus,UnitedStates,201535

2.13InpatientDischargesfromShort-StayHospitals,byRegion,United States,201038

2.14EmergencyDepartmentVisits,bySeasonoftheYear, UnitedStates,201141

2.15InpatientDeaths,per100PersonsHospitalizedforDiagnosis,by First-ListedDiagnosis,UnitedStates,2000,2005,201042

2.16NumberandPercentofEmergencyDepartmentVisits,bySource ofPayment,UnitedStates,201143

2.17NotifiableDiseases,UnitedStates,201649

3.1CasesofAIDS,byState,UnitedStates,201358

3.2TopTenStatesbyNumberofNewHIVDiagnoses,United States,201459

3.3HIVCaseRateper100,000Population,UnitedStates,201260

3.4NumberofVisitswithaDoctororOtherHealthCareProfessional, Adults18YearsofAgeandOlder,byAge,Sex,andRace,United States,201461

3.5EmergencyDepartmentVisits,UnitedStates,201162

3.6HIVCasesRatios,byRaceandTransmission,UnitedStates, 2010–201363

3.7Age-AdjustedDiabetesPrevalenceRatios,bySexandEducation Attainment,Mississippi,2005–201364

3.8HomeHealthandHospiceCareAgencies,byOwnership,Geographic Region,andLocation,UnitedStates,201464

3.9IncidenceRateofSelectedInfectiousDiseases,byYear,UnitedStates, 2000–201368

3.10Age-AdjustedInvasiveCancerIncidenceRates,byRace, California,201368

3.11AsthmaPrevalenceRate,byRaceandSex,201470

3.12PrevalenceofWomenAged18andOlderWhoReportedReceivinga PapanicolaouTestDuringthePastThreeYears,per100Population, byAge,SelectedStatesandTerritories,UnitedStates,201471

3.13PrevalenceofWomenAged50andOlderWhoReportedHavinga MammogramDuringthePastTwoYears,per100Population,by Race,SelectedStates,UnitedStates,201471

3.14CrudeDeathRate,bySexandRace,UnitedStates,2011–201274

3.15Cause-SpecificMortalityRatesforSeveralCausesofDeath,United States,201474

ListofTables,Figures,andExhibits

3.16Age-SpecificMortalityRate,MalignantNeoplasm,United States,201275

3.17Case-FatalityRate,byPathogen,FoodborneInfections,United States,201076

3.18InfantMortalityRate,byRaceofMother,UnitedStates, 1990–201277

3.19NeonatalMortalityRate,byRaceofMother,UnitedStates, 1990–201279

3.20Post-NeonatalMortalityRate,byRaceofMother,UnitedStates, 1990–201280

3.21ProportionateMortalityRatioAmongPlumbers,Pipe/SteamFitters, WhiteMen,byAge,UnitedStates,1971–199581

3.22PotentialYearsofLifeLostCalculationMethod,UsingIndividualLevelInformation81

3.23PotentialYearsofLifeLostCalculationMethod,UsingAgeGroup Information82

3.24PotentialYearsofLifeLost,BeforeAge75,forSelectedCauses ofDeath,UnitedStates,1990–201483

3.25MentalHealthStatusAmongDiabetics,Mississippi,2003–201385

4.1CalculationofRelativeRisk105

4.2AssociationofSmokingandCoronaryHeartDisease (CHD)—RelativeRiskAnalysis106

4.3RetrospectiveStudyDesign2by2Table107

4.4AssociationBetweenSmokingandCoronaryHeartDisease (CHD)—ProportionsAnalysis108

4.5OddsRatioCalculation109

4.6AssociationBetweenSmokingandCoronaryHeartDisease (CHD)—OddsRatioAnalysis110

4.7BirthsandCesareanSectionsintheStudyPopulation111

4.8TotalLiveBirthsAmongMedicaidBeneficiaries111

4.9CesareanSectionRateandRelativeRisk,byAgeofMother112

4.10CesareanSectionRatesandRelativeRisk,byLocale112

4.11MyocardialInfarctionRates,per100,000PopulationandHIV Status113

4.12RiskFactorsforFallsinElderlyPopulation115

5.1OutpatientDepartmentVisits,byAgeandSex,United States,2011119

5.2LungCancerandAlcoholUse120

5.3StratificationbySmokingStatus121

ListofTables,Figures,andExhibits

5.4StandardizationofOutpatientDepartmentVisits,bySex,United States,2011126

5.5CrudeCase-FatalityRates,byAge127

5.6StandardizedCase-FatalityRates127

5.7Standard(Combined)Population128

5.8StandardizedCase-FatalityRatesUsingCombinedStandard Population129

5.9OutpatientVisits,byAgeandRace,UnitedStates,2011131

5.10IndirectStandardizationofOutpatientVisitsRate132

5.11ScreeningProgramData133

5.12IndirectStandardization134

5.13HospitalStandardizedMortalityRatioCalculation136

5.14SeverityofIllnessDistribution138

5.15RecoveryDistribution138

5.16Stratum-SpecificRates138

5.17CrudeRatesforOutpatientVisitsintheHancockRegionalHospital Network141

5.18CrudeRatesforOutpatientVisitsintheHarrisonHospital System141

5.19PopulationDistribution,HancockRegionalHospitalNetwork141

5.20PopulationDistribution,HarrisonHospitalSystem142

5.21StandardPopulationCrudeOutpatientDepartmentVisitRates142

5.22Age-SpecificRateandExpectedCasesforHancockRegionalHospital Network143

5.23Age-SpecificRateandExpectedCasesforHarrisonHospital System143

5.24Age-SpecificRateandExpectedCasesforHancockRegionalHospital NetworkUsingCombinedPopulation144

5.25Age-SpecificRateandExpectedCasesforHarrisonHospitalSystem UsingCombinedPopulation144

5.26CrudeRateforMIComplicationsinJeffersonCounty145

5.27CrudeRateforMIComplicationsinWashingtonCounty145

5.28PopulationDistribution,JeffersonCounty146

5.29PopulationDistribution,WashingtonCounty146

5.30StandardPopulationCrudeMIComplicationRates147

5.31ExpectedMIComplications,JeffersonCounty147

5.32ExpectedMIComplications,WashingtonCounty147

6.1CalculationofLikelihoodRatiosinTestswithDichotomous Results164

ListofTables,Figures,andExhibits

6.2CalculationofLikelihoodRatiosinTestswithPolychotomous Results165

6.3MammographyandPapSmearsResultsforFiscalYear 2015–2016172

6.4ScreeningTestforDiabetes173

7.1WorldwideImpactofSARS,July2003180

7.2WestNileVirusCases,UnitedStates,2016181

7.3ResultsofGastritisInvestigation190

8.1IncidenceofCVDintheEastBankRegionalHospital ServiceArea216

10.1CostAnalysis,Year1260

10.2ProgramCosts,byYear260

10.3Cost-EffectivenessofDiagnosticInterventions263

10.4BenefitsofCommunityOutreachProgram263

10.5Cost-UtilityAnalysisofTreatmentApproaches265

10.6LeadingCausesofDALYs,Worldwide,2000271

10.7LeadingCausesofDALYs,Worldwide,2012272

10.8LeadingCausesofDeath,Worldwide,1990and2020273

10.9CostsofInitiatives,Six-MonthPeriod277

11.1PopulationCharacteristics,byAge283

11.2PersonswithOneHospitalStayinthePastYear,byAge,Sex,and Race,Percent,1999–2016285

11.3PersonswithTwoorMoreHospitalStaysinthePastYear,byAge,Sex, andRace,Percent,1999–2016286

11.4Discharges,byAgeandSex,2014–2016288

11.5DischargeswithatLeastOneProcedure,2011,2016289

11.6DischargeswithatLeastOneProcedure,byAge,2011290

11.7DischargeswithatLeastOneProcedure,byAge,2016290

11.8AverageLengthofStay,byAgeandSex,2014–2016291

11.9PercentOccupancyRate,byHospital,2014–2016292

11.10EastBankHospitalSystemServiceAreaInsuranceCoverage,Persons Under65,Percent,byAge,Sex,andRace294

11.11MedicaidCoverageintheEastBankHospitalSystemServiceArea, byAge,Sex,andRace,2014–2016295

11.12MedicareCoverageintheEastBankHospitalServiceArea,byAge, Sex,andRace,2011,2016295

11.13EastBankHospitalSystemServiceAreaCancerIncidenceRates, per100,000Population,byRaceandSex296

11.14EastBankHospitalSystemServiceAreaPrevalenceofHeartDisease, Cancer,andStroke,Percent,2016297

ListofTables,Figures,andExhibits

11.15EastBankHospitalSystemServiceAreaPrevalenceofDiabetesand PoorGlycemicControl,byAge,Sex,Race,andPovertyLevel, Percent,2016298

11.16ChronicDiseasesintheEastBankHospitalSystemServiceArea, byAge,Sex,Race,andInsuranceCoverage,Percent,2016300

12.1Population,EastBankCounty305

12.2Population,LakeshoreCounty306

12.3UsersofLong-TermCareServices,LakeshoreCounty309

12.4UsersofLong-TermCareServices,EastBankCounty309

12.5UsageRateofLong-TermCareServices,per1,000Persons65Years andOlder,byAge,LakeshoreCountyandWEC-LC316

12.6UsageRateofLong-TermCareServices,per1,000Persons65Years andOlder,byAge,EastBankCountyandWEC-EB316

12.7CurrentLong-TermCareStaffing,LakeshoreCounty319

12.8CurrentLong-TermCareStaffing,EastBankCounty319

13.1EmergencyDepartmentVisits,byAge323

13.2EmergencyDepartmentVisits,byAgeandSex324

13.3EmergencyDepartmentVisits,byAgeandRace326

13.4InjuryVisitstotheEmergencyDepartment,byAgeandSex328

13.5InjuryVisitstotheEmergencyDepartment,byAgeandRace330

13.6PrimaryPaymentSource332

13.7WaitTimeandTimeSpentinEmergencyDepartment333

13.8LeadingPrimaryDiagnosisGroupsatArrival336

13.9DispositionofEmergencyDepartmentVisits337

13.10VisitsResultinginHospitalAdmission338

13.11LeadingPrincipalHospitalDischargeDiagnosisGroupsfor EmergencyDepartmentVisits339

14.1AgeDistributionofAdultPopulation,EastBankCity,2016343

14.2CrescentDoctors,Ltd.,PatientPopulation,byAgeandSex,2011 and2016344

14.3CrescentDoctors,Ltd.,PatientPopulation,byAgeandRace, 2011and2016346

14.4PercentDistributionLengthofTimeSinceLastVisit,Adult Patients,2016348

14.5PercentInsuranceCoverage,AdultsUnder65YearsofAge, 2016349

14.6PercentInsuranceCoverage,AdultsOver65YearsofAge,2016350

14.7PercentDistributionMajorReasonforOfficeVisit,byAge, 2011and2016352

ListofTables,Figures,andExhibits

14.8PercentDistributionMajorReasonforOfficeVisit,bySexandRace, 2011and2016353

14.9PreventiveCareVisits,byAge,Sex,andRace,2016355

14.10PresenceofSelectedChronicConditions,PercentDistribution, byAge,2016356

14.11PresenceofSelectedChronicConditions,PercentDistribution, bySex,2016357

Figures

1.1EpidemiologicData15

2.1PopulationPyramid,UnitedStates,201637

2.2FoodborneOutbreak40

3.1IncidenceRateofReadmissions67

4.1A2by2ContingencyTable91

4.2ExperimentalStudyDesigns94

4.3FrameworkofRandomizedControlledClinicalTrials96

4.4ObservationalStudyDesigns98

5.1DirectMethodofStandardization125

5.2IndirectMethodofStandardization130

6.1Validity2by2ContingencyTable153

6.2ValidityParametersforArthritisScreeningTests156

6.3ValidityParametersforArthritisScreeningTests,Prevalence of10Percent156

6.4ValidityParametersforColorectalCancerScreening157

6.5PredictiveValidityofPreadmissionScreeningTest159

6.6ReliabilityIndex161

6.7ReliabilityIndexCalculation162

6.8LikelihoodRatios163

6.9ROCCurve167

7.1Common-SourceOutbreak179

7.2PropagatedEpidemic179

8.1RVUCalculation199

9.1PatientSatisfactionControlChart230

9.2ControlChartforPatientFalls246

9.3QualityControlChart247

10.1OutcomesofEconomicEvaluations258

10.2PresentValueofCommunityOutreachProgram267

10.3PresentValueofIn-HospitalProgram267

ListofTables,Figures,andExhibits

10.4DiscountedBenefitsofCommunityOutreachProgram268

10.5DiscountedBenefitsofIn-HospitalProgram268

10.6Cost-EffectivenessRatio268

11.1ServiceAreaPopulation,PercentDistribution284

11.2PercentofPatientswithOneHospitalStay,1999–2016,byAge286

11.3PercentofPatientswithTwoorMoreHospitalStays,1999–2016, byAge287

11.4DischargesbySex,per10,000Population,2014–2016289

11.5AverageLengthofStay,byAge,2014–2016292

11.6OccupancyRate,Percent,byHospital,2014–2016293

11.7PrevalenceofDiabetesandPoorGlycemicControl,2016299

12.1PopulationCharacteristics,byRace,EastBankCounty305

12.2PopulationCharacteristics,byAge,EastBankCounty306

12.3PopulationCharacteristics,byRace,LakeshoreCounty307

12.4PopulationCharacteristics,byAge,LakeshoreCounty307

12.5NumberofUsersofLong-TermCareServices,Lakeshore County310

12.6NumberofUsersofLong-TermCareServices,EastBankCounty310

12.7PercentUsersofAdultDayCare,byAge,LakeshoreCounty311

12.8PercentUsersofAdultDayCare,byAge,EastBankCounty311

12.9PercentUsersofHomeHealthServices,byAge,Lakeshore County312

12.10PercentUsersofHomeHealthServices,byAge,EastBank County312

12.11PercentUsersofHospiceServices,byAge,LakeshoreCounty313

12.12PercentUsersofHospiceServices,byAge,EastBankCounty313

12.13PercentUsersofNursingServices,byAge,LakeshoreCounty314

12.14PercentUsersofNursingServices,byAge,EastBankCounty314

12.15PercentUsersofResidentialCareCommunity,byAge,Lakeshore County315

12.16PercentUsersofResidentialCareCommunity,byAge,EastBank County315

12.17UsageRateofLong-TermCareServicesAmongPersons65Yearsand Older,per1,000People65YearsandOlder,byAge,Lakeshore CountyandWEC-LC317

12.18UsageRateofLong-TermCareServicesAmongPersons65Yearsand Older,per1,000People65YearsandOlder,byAge,EastBankCounty andWEC-EB317

12.19UsageRateofLong-TermCareServicesAmongPersons85Yearsand Older,per1,000People65YearsandOlder,byAge,Lakeshore CountyandWEC-LC318

12.20UsageRateofLong-TermCareServicesAmongPersons85Yearsand Older,per1,000People65YearsandOlder,byAge,EastBankCounty andWEC-EB318

13.1EmergencyDepartmentVisits,byAge(Visitsinthousands)323

13.2EmergencyDepartmentVisits,byAgeandSex(Visitsin thousands)325

13.3UtilizationRateofEmergencyDepartmentVisits,byAgeandSex (per100personsperyear)325

13.4EmergencyDepartmentVisits,byAgeandRace(Visitsin thousands)327

13.5UtilizationRateofEmergencyDepartmentVisits,byAgeandRace (per100personsperyear)327

13.6RateofInjury-RelatedEmergencyDepartmentVisits,byAge (per100personsperyear)329

13.7RateofInjury-RelatedEmergencyDepartmentVisits,byAgeandSex (per100personsperyear)329

13.8RateofInjury-RelatedEmergencyDepartmentVisits,byAgeand Race(per100personsperyear)331

13.9PrimaryPaymentSource,Percent332

13.10WaitTimeinEmergencyDepartment,byNumberofVisits334

13.11WaitTimeinEmergencyDepartment,Percent334

13.12DurationofEmergencyDepartmentVisit,byNumberofVisits335

13.13DurationofEmergencyDepartmentVisit,Percent335

13.14PrimaryDiagnosisatArrival,Percent,SelectedDiagnoses337

14.1AgeDistribution,Percent343

14.2OfficeVisits,byAge,Percent,2011and2016345

14.3OfficeVisits,Whites,Percent,2011and2016347

14.4OfficeVisits,Blacks/AfricanAmericans,Percent,2011and2016347

14.5PaymentSources,AdultsUnderAge65,Percent350

14.6PaymentSources,AdultsOverAge65,Percent351

14.7MajorReasonforVisit,byAge,2011and2016352

14.8MajorReasonforVisit,bySex,2011and2016353

14.9MajorReasonforVisit,MalesbyRace,2011and2016354

14.10MajorReasonforVisit,FemalesbyRace,2011and2016354

14.11TopFiveChronicDiseases,Percent,byAge,2016356

14.12TopFiveChronicDiseases,Percent,bySex,2016357

Exhibits

2.1ICD-10-CMCodes24

2.2NationallyNotifiableInfectiousDiseases,UnitedStates,201648

9.1AHRQChecklist248

PREFACE

Thisbookisintendedtointroducethestudentandpractitionerofhealth caremanagementtothenotionofhealthcareforpopulationsand thescienceofepidemiology.Whenthefirsteditionofthisbook, Designing HealthCareforPopulations:AppliedEpidemiologyinHealthCareAdministration (Jossey-Bass,2000),waswrittenalmost20yearsago,outsidethefield, epidemiologywasviewedbymanyasaquestionablyrelevant,butcertainly complicatedsetofterms,formulas,andstatistics.Thisviewwasalsoprevalent whenthesecondedition, ManagerialEpidemiologyforHealthCareOrganizations (2ndedition;Jossey-Bass,2005),waspublished.However,giventherecent changesinhealthcarereform,epidemiologyisnowrecognizedasacore disciplinepertinenttoallbranchesofhealthcare,includingmanagement. Theinitialmotivatingpurposeofthetextwastoillustrateboththerelevance andbenefitofepidemiologyinthefieldofhealthcaremanagementand populationhealthmanagement.

Thisisstillthecasewiththislatestedition.Thisrevisededitionhas beenjointlywrittenbyauthorswhobringamedical,managerial,and epidemiologicalperspectivetothework.Contemporaryapplicationsof epidemiologyinhealthcaremanagementincludemonitoringqualityand effectivenessofclinicalservices,strategicandprogramplanning,marketing,

andinsuranceandmanagedcare—aswellassuchtraditionalusesastumor registries,infectioncontrolprograms,andpublichealthprogramming. Thisnewestversionhasbeenwrittentointroduceepidemiologyprinciples, reinforcethetraditionalusesofcontemporaryepidemiology,andattempt toillustrateclearlythecontemporaryusesinplanning,evaluating,and managinghealthcareforpopulations.Healthcarereforminitiativesare discussedthroughout,withemphasisontheinfluenceofepidemiological principles.

Perhapsthemostimportantpurposeofthisbookisteachingthepractical applicationofepidemiologyinhealthcaremanagement.Eachchapterhas beenwrittentopresentepidemiologicprinciples,followedbyexamplesand applications.Concepts,examples,andcasestudiesarepresentedtoallowthe studentandpractitionerawaytounderstandepidemiologyanditsapplicationinthedesignandmanagementofhealthcareforpopulations.

Thetextisorganizedinthefollowingmanner.ChapterOneintroduces thereadertothescienceofepidemiology.Definitionsofepidemiologyandan overviewofitshistoryinmanagementarepresented.Also,thetransitionfrom thetraditionalroleofhealthcaremanagementtoitsnewroleinpopulation healthisoutlined.Ahistoricalperspectiveonthedevelopmentofepidemiologyintoascientificdisciplineispresented.Recenthealthcarereformis presented.

ChapterTwodiscussesthehealthandneedsofpopulationsanditsusein management.Includedinthischapterisadiscussionofcommonlyavailable sourcesofdata.ChapterThreepresentsepidemiologicalmeasuresusedin healthcare,withemphasisonthosemeasuresofimportancetomanagers. ChapterFourpresentsstudydesignsandmeasuresofassociationofthecause andeffectrelationshipofhealthanddiseaseacrossandamongpopulations. Clinicaltrials,asanexampleofexperimentalstudydesigns,arepresented, alongwiththemorecommonplaceobservationaldesigns.ChapterFive introducestheconceptofconfounding,theproblemofmisleadingdata interpretation,andmethodstoaddressthisproblem.Includedinthis chapterisadiscussionofthestandardizationofepidemiologicdataandrisk adjustment.

ChapterSixintroducesclinicalepidemiologyasthecoredisciplineof clinicaloutcomesresearch,clinicaleffectiveness,andmedicalmanagement. Thischaptercoverstopicsincludingvalidityandreliabilityandothermeasuresoftestperformance.ChapterSeven,whichisanewchapterinthis edition,presentsinfectiousdiseaseepidemiology,includingepidemiological

Preface xxv surveillanceandmonitoringinfections.Healthcare–associatedinfections arediscussed.ChapterEight,anothernewchapter,coversreimbursementmethodsinusetodayandtheroleofepidemiologyindetermining reimbursementandperformance.ChapterNineprovidesadiscussion ofhealthoutcomesassessmentandtherelationshipbetweentraditional epidemiologicalconcepts;benchmarking,bestpractice,practiceguidelines, andthemeasurementofqualityofcarearepresented.

ChapterTendescribestherelationshipbetweenepidemiologyand economicanalysis,includingthemannerinwhichepidemiologicalmeasures areusedintheevaluationofhealthcaredeliveryandtheformulationof healthcarepolicyforpopulations.Burdenofdiseaseisdiscussed,witha focusontheeconomicimpactofdisease.

ChaptersEleventhroughFourteenpresentcasestudiesoftheapplicationofepidemiologytotheplanningforandmanagementofhealthcare forpopulations.ChapterElevenpresentsacasestudyfocusingonhospital inpatientservices.Theintentofthischapteristoapplygeneralconceptspresentedthroughoutthetexttoestablishingaplanforrealignmentofinpatient hospitalservices.ChapterTwelvepresentsacasestudyfocusingonlong-term care.ChapterThirteenpresentsacasestudyillustratingtheapplicationof epidemiologytothestudyofemergencyroomservicesinahospitalnetwork. ChapterFourteenpresentsacasestudyfocusingonphysicianpractices.

Eachchapterissupplementedwithstudyquestions.Thepurposeofthe studyquestionsistoaidthereaderinunderstandingandapplyingtheepidemiologicconceptspresentedwithinamanagementcontext.

Weanticipatethattheprimaryusersofthistextwillbehealthcare managementstudentsandpractitioners,forwhomwehavepresented thematerialinapracticalandappliedmanner.Thisbookcanserveasa classroomtextaswellasanon-the-jobreferenceforpractitioners.After readingandusingthisbook,weexpectthatthestudentorpractitionerwill understandandappreciatetherelevanceofepidemiologyandlookforward tousingitineverydayhealthcaremanagementpractice.

Thepreparationofthisworkhasbeentheresultofamultiyearcollaboration,whosefirstproductwasthepreviouslymentionedtext.Theauthors ofthefirsttwoeditionshaveworkedtogetherformorethan30years.This editionhasathirdauthor,whowasourstudentandnowisacolleague.

Finally,wewouldliketothankthestudentsatTulaneUniversityMedical CenterSchoolofPublicHealthandTropicalMedicine,theUniversityof Wisconsin-MadisonMedicalSchool,theUniversityofIndianaatSouthBend,

xxvi Preface

theUniversityofSt.ThomasGraduateSchoolofBusiness,theUniversity ofAlabamaBirmingham,SchoolofHealthRelatedProfessionswhose commentsonpreviousworkhavebeenincorporatedintoalleditions.Their collectivefeedbackhasimprovedthisbooksignificantlyfromitsprevious incarnations.Errorsofomissionremaintheresponsibilityoftheauthors.

THEAUTHORS

PeterJ.Fos isaprofessorofhealthpolicyandsystemsmanagementat LouisianaStateUniversityHealthSciencesCenter,SchoolofPublicHealth. HeearnedhisdoctoraldegreeinhealthcaredecisionanalysisatTulane UniversityGraduateSchoolfollowingacareerinclinicaldentistry.Before heassumedhiscurrentposition,heheldseveraladministrativeandfaculty positions,includingpresidentoftheUniversityofNewOrleans,executive vicepresidentandprovostandprofessorattheUniversityofTexasat Tyler,deanandprofessoroftheCollegeofHealthatTheUniversityof SouthernMississippi,andasthechiefscienceofficeroftheMississippi StateDepartmentofHealth,professorofclinicaldentistryattheUniversity ofNevadaLasVegas,andassociateprofessoratTulaneUniversitySchool ofPublicHealthandTropicalMedicine.Hehasspentthepast35years teachingandincurriculumdevelopmentoftheapplicationofepidemiology tomanagement,aswellasthepracticeofmanagerialepidemiology,clinical effectiveness,andhealthoutcomesresearch.Heisavisitingscholaratthe MedicalUniversityofSouthCarolina.

DavidJ.Fine waspresidentandCEOoftheCatholicHealthInitiatives InstituteforResearchandInnovationfrom2013to2016,atwhichtime heretiredandcommencedapart-timesecondcareerasamanagement andeducationalconsultantwithBaystateAssociates.AttheInstitute,he

TheAuthors

wasresponsibleforclinicalresearchactivitiesat125hospitalsnationwide, withemphasisoncompliancematters.Priorto2013,DavidwasCEOofa numberofnationallyknownhealthsystemsoverthecourseofa40-year healthcaremanagementcareer,includingSt.Luke’sEpiscopalHealthSystem (Houston),TheUniversityofAlabamaatBirminghamHealthSystem,Tulane UniversityHospitalandClinic,andWestUniversityHospitalandClinic.His careerhasincludedseniorleadershiprolesinlarge,multi-specialtygroup practicesandmanagedcareorganizations.Concurrentwithhisadministrativeresponsibilities,Fineheldanumberofacademicappointments, mostrecentlyastenuredprofessorattheBaylorCollegeofMedicine.His bibliographyincludesmanypublicationsinleadingjournalsaswellasfive books.In1985FinewastherecipientoftheprestigiousHudgensMedalfrom theAmericanCollegeofHealthcareExecutives,ofwhichheisaLifeFellow. In2007hereceivedadoctorofphilosophydegreehonoriscausafromthe UniversityofSouthernMississippi.

MiguelA.Zúniga isanassociateprofessorattheSamHoustonState University(SHSU)DepartmentofPopulationHealth.Heisformerchairof theDepartmentofHealthServicesandPromotionattheSHSUCollege ofHealthSciences.Dr.Zúnigaworkswithstudentsinprogramsinpublic health,healthcareadministration,wellnessmanagement,healthsciences, andbilingualhealthcarestudies.Priortohisacademicleadershiproleat SamHouston,Dr.Zúnigaheldprimaryfacultyandacademicadministrator appointmentsattheTexasA&MHealthScienceCenter–SchoolofRural PublicHealthCampusinMcAllen,Texas.Additionally,Dr.Zúnigaheldthe positionofmasterofpublichealthprogramdirectorattheMedicalCollege ofGeorgia,clinicalassistantprofessoratTheTulaneUniversitySchoolof PublicHealthandTropicalMedicine,andclinicalinstructoratTheNational UniversityofHondurasSchoolofMedicine.

Dr.ZúnigacompletedhismedicaldoctordegreeinhisnativeHonduras andasarecipientofaFulbrightScholarshipobtainedamasterofhealth administrationandadoctorofpublichealthdegreefromTulane.

ManagerialEpidemiology forHealthCareOrganizations

CHAPTERONE

EPIDEMIOLOGYINHEALTHCARE ADMINISTRATION

ChapterOutline

Introduction

PhilosophicalFramework

FocusandUsesofEpidemiology

ObservationalEpidemiology

ExperimentalEpidemiology

PreventiveMedicine

HealthCareReform

TheConceptofPopulationsandCommunities

ManagingHealthCareforPopulationsandCommunities

RoleofEpidemiology

Summary

StudyQuestions

LearningObjectives

Thereaderwillbeableto:

•Deﬁneepidemiology

•Discussthehistoryofepidemiology

•Deﬁnemanagerialepidemiology

•Discussthedistinctionbetweenobservationalandexperimental epidemiology

•Describetheusesofepidemiology

•Describetheﬁeldofsocialepidemiology

•Discusstheconceptofpopulationsandpopulationhealthcare management

Introduction

Epidemiologyisrecognizedasacoredisciplinewithinthefieldofpublic health.Itisauniquedisciplinewhichformallybeganasaresultofthe sanitaryreformmovementin17thand18thcenturyEngland.Epidemiology isformallydefinedinanumberofways.First,epidemiologyisthestudyofthe distributionanddeterminantsofdiseasesandinjuriesinhumanpopulations (MausnerandKramer,1985).Aseconddefinitionemphasizesthestudyofall factors,andtheirinterdependence,thataffecttheoccurrenceofhealthand diseaseinpopulations.Finally,epidemiologyisthestudyofthedistribution anddeterminantsofhealth-relatedstatesandeventsindefinedpopulations, andtheapplicationofthisstudytothecontrolofhealthproblems(Last, 1995).

Commontoalloftheprecedingdefinitionsistheconceptof populations Individualsarenotthefocusofepidemiology,butrathergroupsofindividuals.Populationsmayrepresentlargegroupslikethetotalpopulationofthe UnitedStates,aswellassmallgroupssuchastheemployeesofafactory,store, orgovernmentagency.Centraltotheconceptofpopulationsisthatgroups ofindividualsexhibitcertaincommonalities.Forexample,agroupofindividualswhoarerelatedgeographically,suchasthoselivinginthesamecity, representapopulation.Also,agroupofindividualswhoworkinthesamesettingareapopulation.Andagroupofindividualswholiveandworktogether areapopulation,asinthecaseofmilitarypersonnel.Groupsofindividuals ofthesameraceorethnicgrouparealsoconsideredpopulations.

Historically,epidemiologyisadisciplinethathasexperiencedlongand distinctdevelopmentstages.Itisreasonabletothinkthatepidemiologybegan whenmanfirstwalkedonearth.Thetheoryof“survivalofthefittest”canbe extendedtoassumethatearlymanacquired,overtime,anunderstandingof therelationshipbetweenenvironmentandhealth.Onesimpleexampleisthe useofanimalhidesandfursasprotectiveclothing.

TherelationshipbetweentheenvironmentandhealthanddiseaseismentionedintheOldTestamentoftheBible.However,itwasn’tuntiltheGreek civilizationwasestablishedthatepidemiologybegantoemergeasascientific

discipline.Hippocrates,wholivedfrom460to377B.C.,wrotetheclassicwork “OnAirs,Waters,andPlaces.”Hisworkbeganwhatisreferredtotodayasenvironmentalepidemiology.Hiswritingsdiscussedthelinkbetweentheenvironmentandhumanhealth.Hippocratesprovidedaccuratedescriptionsofthe diseasestetanus,typhus,andphthisis(SingerandUnderwood,1962).His contribution,whichisthefirstdocumenteduseofobservationaltechniques, earnedHippocratesthetitleoffatherofepidemiologyandthedesignation asthefirstepidemiologist(NewcombandMarshall,1990).

GirolamoFracastorius,wholivedfrom1478to1553,firstproposedwhatis nowknownas germtheory (Ackerknecht,1982).Hestudiedepidemicsandwas thefirsttomakeascience-backedstatementofthenatureofcontagion,infection,diseasegerms,andmodesoftransmission.Heidentifiedwaysinwhich infectionscanbetransmitted.Hediscoveredthatinfectionwastransmitted bydirectcontact,throughdropletspread,fromcontaminatedclothing,and throughtheair.Severalhundredyearslater,LouisPasteurwouldprovehis theorieswereaccurate.

ThomasSynenham,wholivedinthe17thcentury,iscalledtheEnglish Hippocrates(Meynell,1988).Here-emphasizedthetheoriesofHippocrates andexpandedthemtothe17thcentury.Hewasthefirsttodescribethe clinicalmanifestationsoftheconditionknownasBell’sPalsy.Here-initiated scientificobservationsofhealth,Hippocrates’contribution,intothecore fabricofmodernepidemiology.

JamesLind,wholivedfrom1716to1794,wasthefirstknownclinical epidemiologist.Asapioneerofnavalhygiene,heworkedasasurgeon’smate andsailedformanyyearsaroundtheworld.Heperformedexperimentsin anattempttodeterminethecauseofscurvy.Scurvy,whichcauseslooseteeth, bleedinggums,andhemorrhages,affectedsailors.Lindadjustedtheirdiets byaddingfoodssuchascider,garlic,mustard,horseradish,vinegar,oranges, andlemons.Henotedthatthesailorswhoateorangesandlemonsrecovered fromtheeffectsofscurvy,provingLind’stheorythatcitrusfruitswerethebest treatmentforthedisease.TodayweknowthatscurvyiscausedbyaVitamin Cdeficiency.Laterinthislife,Lindcontributedtotheknowledgeoftyphus feveronshipsandchronicleddiseases.

MedicalregistrationofdeathsbeganinGreatBritainin1801.William Farr(1807–1883),astatisticalabstracterintheGeneralRegistryOfficein London,establishedanationalsystemofrecordingcausesofdeath(Eyler, 1980).ThisstandardclassificationsystemwastheprecursortotheInternationalClassificationofDiseasesandRelatedConditions(ICD),whichwillbe discussedinChapterTwo.Farr’sothercontributionsincludedinvolvement inthefirstmoderncensus,useofthecensustocollectspecificinformation

ManagerialEpidemiologyforHealthCareOrganizations ondiseasesandconditions(blindnessanddeafness),andinventionofthe standardizedmortalityrate(NewcombandMarshall,1990).

AcolleagueofWilliamFarr,JohnSnow,usedepidemiologicprinciplesto studyoutbreaksofcholerainLondoninthe1850s(Lilienfeld,2000).Snow demonstratedhowscientificevidencecanbeusedtosupporthypothesesand analyticalinvestigations.Heidentifiedthesourceoftheinfectiousagent,contaminatedwaterintheBroadStreetpump,andtheetiologyofthecholera outbreak(Collins,2003).Hisworkhasbeendescribedasabrilliantuseof descriptiveandquantitativeepidemiologicprinciples(Winkelstein,1995).

Asthe20thcenturybegan,epidemiologywasinvolvedwithinfectiousand communicablediseases.Themaincauseofthesediseaseswasovercrowded conditionsinthecitiesoftheworld.In1900,theleadingcausesofdeath werepneumoniaandinfluenza,followedcloselybytuberculosis.Other leadingcausesofdeathin1900werediarrhea,heartdisease,andnephritis. Asthe20thcenturyprogressed,chronicdiseasesbecamemorepronounced ascausesofdeath.In1930,heartdiseasebecametheleadingcauseof death,asitistoday.Theemergenceofchronicdiseasesastheleadinghealth concerncontinuedthroughthe1940sand1950s,withinfectiousdiseases becominglessofaconcern.Thedifferencebetweenthedeathratesof chronicandinfectiousdiseaseswaswideningasthe20thcenturymoved along.Bytheendofthe20thcentury,theonlyinfectiousdiseasesremaining inthetoptenofleadingcausesofdeathwerepneumoniaandinfluenza.

TheperiodoftimedemarcatedbyWorldWarIIisthebeginningof anotherimportantperiodinthedevelopmentofepidemiologyasascientific discipline.Epidemiologymethodscontinuedtoevolve,withafocusonindividualdiseasesandconditions.Thecase-controlstudydesignwasdeveloped duringthe1930s.Cohortstudieswerepursuedtoobservetherelationship oftobaccousageanddisease.Case-controlstudiesbecameverypopular inhospital-basedstudies,beginningin1950(DollandHill,1950;Levin, Goldstein,andGerhardt,1950;WynderandGraham,1950).Since1950 epidemiologyhascontinuedtodevelop,ascohortstudiesandclinicaltrials havegainedpopularity.Well-knowncohortstudiesincludetheFramingham HeartStudy,theBogalusaHeartStudy(Gordonandothers,1977;Voorsand others,1976),andtheJacksonHeartStudy(Auerbachandothers,2017).

Atthedawnofthe21stcentury,epidemiologyhasbeguntoexpand itsfocustohealthstatus,health-relatedqualityoflife,andburdenofdisease. AsaresultofeventsofSeptember11,2001,epidemiologyhasgainednew rolesinbioterrorismpreparednessandmanagementofhealthcareservices. Withthesignificantnumberofemerginginfectiousdiseases(including