Designing Health Care for Populations

by Peter J. Fos (Mississippi Department of Health ); David J. Fine (University of Alabama, Birmingham )

• ISBN13: 9780787952266
• ISBN10: 0787952265
• Format: Hardcover
• Copyright: 2000-01-01
• Publisher: Jossey-Bass

Summary

In clear, easy-to-understand terms, Designing Health Care for Populations reveals how the science of epidemiology--the study of the causes, distribution, and control of disease in a population--can be implemented to lead all health care organizations. The authors, experts in health care management, decision science, and epidemiology, offer health care managers an essential resource for understanding the common bond between clinical medicine and the management of health care facilities. The book is filled with step-by-step guidelines for applying the discipline of epidemiology to the full spectrum of management operations. Tapping into the knowledge, information, and guidelines in this book, health care professionals can learn to apply the principles of managerial epidemiology to help them achieve clinical improvement, integrate health care services, organize providers into networks, and evaluate and document organizational quality.

Author Biography

David J. Fine, M.H.A. is president and CEO of the University of Alabama at Birmingham Health System.

Table of Contents

List of Figures and Tables	xix
Preface	xxvii
The Authors	xxxi
Introduction	1	(10)
Definition of Epidemiology	2	(1)
Focus of Epidemiology	2	(1)
Observational Epidemiology	3	(1)
Experimental Epidemiology	3	(1)
Uses of Epidemiology	3	(1)
Health Care Reform	4	(1)
Traditional Role of Health Care Management	5	(1)
The Concept of Populations	6	(1)
New Role of Health Care Management	7	(2)
Managing Health Care for Populations	7	(2)
Summary	9	(1)
Study Questions	10	(1)
Describing Health and Needs of Populations	11	(26)
Introduction	12	(1)
Health and Disease	12	(5)
International Classification of Disease	13	(2)
Current Procedural Terminology	15	(1)
Diagnosis Related Groups	15	(2)
Sources of Descriptive Information	17	(5)
Vital Statistics	18	(2)
Medical Records	20	(2)
Person Variables	22	(9)
Age	22	(2)
Sex	24	(1)
Race or Ethnicity	25	(3)
Marital Status	28	(1)
Social Class	28	(2)
Population Pyramids	30	(1)
Place Variables	31	(1)
Time	32	(2)
Other Descriptive Variables	34	(1)
Summary	35	(1)
Study Questions	36	(1)
Measuring Health and Needs of Populations	37	(24)
Introduction	38	(1)
Counts	38	(1)
Rates	39	(16)
Incidence Rate	43	(3)
Prevalence Rate	46	(2)
Period Prevalence	48	(1)
Mortality Rates	49	(5)
Other Rates	54	(1)
Ratios	55	(1)
Proportions	55	(1)
Summary	56	(1)
Study Questions	57	(4)
Designs to Study the Health and Needs of Populations	61	(18)
Introduction	62	(1)
Risk and Causation	62	(1)
Typology of Study Designs	63	(2)
Descriptive Study Designs	65	(1)
Analytic Study Designs	65	(8)
Prevalence Study Designs	65	(2)
Prospective Study Designs	67	(1)
Measuring Effect of Exposure in Cohort Studies	67	(3)
Retrospective Study Designs	70	(2)
Measuring Effect of Exposure in Retrospective Studies	72	(1)
Application to Managerial Epidemiology	73	(3)
Summary	76	(1)
Study Questions	76	(3)
Standardizing Population Health Information	79	(28)
Introduction	80	(2)
Standardization of Information	82	(12)
Direct Method of Standardization	82	(6)
Indirect Method of Standardization	88	(6)
Stratification	94	(1)
Risk Adjustment	95	(2)
Summary	97	(1)
Study Questions	98	(9)
Clinical Considerations in Population Health Care	107	(28)
Introduction	108	(1)
Clinical Trials	109	(2)
Clinical Effectiveness	111	(11)
Validity	112	(4)
Reliability	116	(2)
Impact of Test Information	118	(4)
Managerial Aspects of Validity	122	(2)
Disease Management	124	(1)
Infectious Disease Epidemiology	124	(4)
Infectious Epidemics	126	(2)
Managerial Concerns of Infectious Epidemics	128	(1)
Surveillance	129	(1)
Summary	130	(1)
Study Questions	131	(4)
Assessing Population Health Outcomes	135	(20)
Introduction	136	(1)
Health Outcomes	136	(6)
Outcomes Assessment	136	(1)
Outcomes Measurement	137	(3)
Outcomes Monitoring	140	(1)
Uses of Outcomes Assessment	141	(1)
Benchmarking	142	(2)
Best Practices and Practice Guidelines	144	(3)
Application of Best Practice Assessment	145	(2)
Health Status Assessment	147	(1)
Quality of Health Care Services	148	(2)
Quality of Medical Care	149	(1)
Assessment of Quality	150	(3)
The Malcolm Baldrige National Quality Program	150	(1)
Standard of Care	151	(1)
Quality Measures	151	(1)
Data Sources	152	(1)
Summary	153	(2)
Marketing Health Care for Populations	155	(14)
Introduction	156	(1)
Marketing	156	(1)
New Role of Marketing	157	(2)
Marketing the Health Care System	158	(1)
Community Health Status Evaluation	158	(1)
Integrated Health Care Services	159	(1)
Data Types	159	(1)
Sampling	160	(1)
Market Research	161	(6)
Data Collection	161	(2)
Market Research Data Analysis	163	(1)
Patient Satisfaction	164	(1)
Demand Estimation	164	(2)
Validity and Reliability of Market Research	166	(1)
Summary	167	(1)
Study Questions	167	(2)
Economic Analysis of Health Care for Populations	169	(16)
Introduction	170	(1)
Economic Evaluation	171	(1)
Cost Analysis	172	(1)
Discounting	173	(3)
Cost-Benefit Analysis	176	(1)
Cost-Effectiveness Analysis	177	(2)
Cost-Utility Analysis	179	(1)
Role of Epidemiology	180	(2)
Summary	182	(1)
Study Question	183	(2)
Applied Epidemiology for Managers: Emergency Health Care	185	(20)
Introduction	186	(1)
Population Characteristics	186	(1)
Demographics	187	(3)
Age	187	(2)
Sex	189	(1)
Race	189	(1)
Payment Source	189	(1)
Study Question	189	(1)
System Utilization Trends	190	(8)
Hospital Type Utilized	190	(1)
Major Reason for Visit	191	(2)
Patient Disposition	193	(1)
Study Question	194	(1)
Risk of Inpatient Hospital Admission	194	(1)
Risk of Urgent Visit	195	(1)
Risk of Alcohol- or Drug-Related Visit	196	(2)
Resource Utilization	198	(3)
Study Question	199	(2)
Risk of Resource Utilization	201	(1)
Study Question	201	(1)
Community-Based Education	201	(2)
Study Questions	202	(1)
Health Care System Expansion	203	(2)
Study Questions	203	(2)
Applied Epidemiology for Managers: Hospital Care	205	(16)
Introduction	206	(1)
Population Characteristics	207	(1)
Demographics	207	(3)
Age	207	(1)
Sex	208	(1)
Race	208	(1)
Payment Source	209	(1)
Study Question	210	(1)
System Utilization Trends	210	(6)
Diagnosis Coding	211	(1)
Study Question	212	(1)
Risk of Long Stay	212	(1)
Study Questions	213	(3)
Hypothesis Testing	216	(2)
Study Questions	216	(2)
Management Decisions	218	(1)
Study Questions	218	(1)
Managed Care Contracting	218	(1)
Study Questions	218	(1)
Quality of Care	219	(2)
Study Questions	219	(2)
Applied Epidemiology for Managers: Health and Work Productivity	221	(16)
Introduction	222	(1)
Population Characteristics	222	(7)
Study Questions	224	(5)
Health Status	229	(2)
Study Questions	230	(1)
System Resources Utilization Trends	231	(2)
Study Questions	232	(1)
Population Description	233	(1)
Study Questions	233	(1)
Community Relations	234	(1)
Study Questions	234	(1)
Managerial Decision Making and Strategic Planning	234	(3)
Study Questions	235	(2)
Applied Epidemiology for Managers: Regional Pediatric Inpatient Services	237	(14)
Introduction	238	(1)
Population Characteristics	238	(4)
Study Question	238	(1)
Study Questions	239	(2)
Study Questions	241	(1)
System Resource Utilization Trends	242	(3)
Study Questions	243	(2)
Population Description	245	(6)
Study Questions	246	(5)
Applied Epidemiology for Managers: Senior Care	251	(12)
Introduction	252	(1)
Population Characteristics	252	(3)
Study Questions	252	(1)
Study Questions	253	(2)
Study Questions	255	(1)
System Resource Utilization Trends	255	(5)
Study Questions	259	(1)
Study Questions	259	(1)
Study Questions	259	(1)
Managerial Decision Making: Population Description	260	(1)
Study Questions	260	(1)
Managerial Decision Making: Negotiating Contracts	261	(2)
Study Questions	261	(2)
Appendix I Overview of Hypothesis Testing	263	(6)
Introduction	263	(1)
Testing a Single Population Mean	264	(2)
Illustrative Example 1	264	(2)
p-Values	266	(1)
t-Distribution	266	(1)
X2 Distribution	267	(2)
Appendix II One-Sided Hypothesis Tests	269	(2)
Introduction	269	(2)
Illustrative Example 1	269	(2)
Appendix III Statistical Power	271	(6)
Introduction	271	(1)
Power	272	(5)
Illustrative Example 1	273	(1)
Illustrative Example 2	273	(1)
Illustrative Example 3	274	(1)
Illustrative Example 4	274	(3)
Appendix IV Sample Size	277	(4)
Introduction	277	(1)
Sample Size for Estimating Means	277	(2)
Illustrative Example 1	279	(1)
Sample Size for Estimating Proportions	279	(2)
Illustrative Example 2	280	(1)
Appendix V Hypothesis Testing Using Categorical Data	281	(6)
Introduction	281	(1)
Contingency Table Method	281	(3)
Illustrative Example 1	282	(1)
Illustrative Example 2	283	(1)
Yates Corrected Chi-Square Test for a 2 X 2 Contingency Table	284	(3)
Illustrative Example 3	285	(2)
Appendix VI Extreme Values: Outliers	287	(10)
Introduction	287	(1)
Identification of Outliers	287	(2)
What to Do with Outliers	289	(2)
References	291	(6)
Index	297