Healthcare Systems 2 - Final Exam

Incidence Rate

Measures the number of new cases of a condition in a population over a specific time.

Prevalence Rate

Measures the total number of existing cases (both new and old) in a population at a specific time.

Morbidity

Refers to illness, disease, or health conditions affecting an individual or population.

Mortality

Refers to death rates within a population

Proportional Days Covered (PDC)

Calculates the percentage of days a patient has access to medication within period

PDC =

number of days with drug on hand / number of days in a specific interval * 100%

What PDC is considered adherent?

80% or greater

A patient has medication for 72 days within a 90-day observation period. What is the PDC for this patient. Is this patient adherent?

72 days/ 90 days *100% = 80%

Yes, this patient is adherent

What behavior theories introduced the concept of Subjective norms (Social pressures influencing behavior)

Theory of Reasoned Action (TRA) & Theory of Planned Behavior (TPB)

Subjective norms

these are social pressures from family, peers, or society that influence choices

Social Cognitive Theory (SCT) adds __________ to TRA and TPB

social norms through observational learning and modeling

Social norms under SCT influence decisions because

people observe others and adjust their actions accordingly

Perceived Susceptibility

One's belief about the likelihood of developing a condition.

Perceived Severity

How serious a person believes the consequences of the condition will be.

Perceived Benefits

Belief in the advantages of taking action

Perceived Barriers

Recognized obstacles to changing behavior.

Cue to Action

Triggers that prompt behavior change

Self-Efficacy

Confidence in one's ability to perform the behavior

"I have a family history of diabetes, so I might be at risk of developing it too."

Perceived Susceptibility

This reflects an individual’s belief in their likelihood of experiencing a health condition.

"If I get diabetes, it could lead to serious complications like heart disease or nerve damage."

Perceived Severity

Demonstrates how serious a person believes a health issue will be.

"Regular exercise and a healthy diet can lower my risk of diabetes and improve my overall health."

Perceived Benefits

Highlights the advantages an individual associates with taking preventive action.

"Healthy food is expensive, and I don't have time to exercise every day."

Perceived Barriers

Represents obstacles that may prevent behavior change.

"My doctor just warned me that my blood sugar levels are rising, so I need to start making healthier choices."

Cue to Action

An external trigger prompting action, such as a doctor’s advice, media campaigns, or symptoms.

"I've successfully built a workout routine before, so I know I can commit to making healthier choices again."

Self-Efficacy

Reflects the confidence in one’s ability to perform a behavior.

HBM assumes that

individuals take action when they perceive a Real threat or risk

The Theory of Reasoned Action (TRA) was developed by

Martin Fishbein & Icek Ajzen in the 1970s.

Constructs of Theory of Reasoned Action

Attitudes Toward Behavior

Subjective Norm

Subjective Norm

Influence of others on one’s behavior.

- If an individual believes others expect them to act in a certain way, they are more likely to comply with that expectation.

A person may decide to quit smoking because their family and friends actively encourage them to stop

Example of Subjective Norms

Attitudes Toward Behavior

-Personal evaluation of an action.

-Refers to an individual’s personal evaluation of performing an action.

-People assess whether a behavior is positive or negative, which influences their likelihood of engaging in it.

A person who believes exercising is enjoyable and beneficial is more likely to work out regularly

Example of Attitudes Toward Behavior

Perceived Behavioral Control

The individual's belief about ease or difficulty in performing the behavior.

-The degree to which an individual believes they have the ability and resources to perform a behavior

- It accounts for self-efficacy (internal confidence) and external factors (availability of resources)

Someone wanting to eat healthy may struggle if they perceive healthy food as expensive or feel they lack cooking skills, even if they have a strong intention to eat better

Example of Perceived Behavioral Control

Trans theoretical Model (TTM)

Stages of change. Views behavioral changes as a cyclic process (not linear)

TTM Pre-Contemplation

No intention to change behavior

TTM Contemplation

Acknowledging the need for change

TTM Preparation

Making plans to take action

TTM Action

Actively engaging in behavior change

TTM Maintenance

Sustaining the change long-term

TTM Termination

The behavior is ingrained, and relapse is highly unlikely

Patient-reported outcomes (PROs) focus on

Patient perception, Subjectivity, and Retrospective study

PROs Patient Perceptions

Captures individual experiences regarding health status

A patient with arthritis may rate their pain level or mobility difficulties, even if diagnostic tests show mild inflammation.

Example of PROs Patient Perceptions

PROs Subjectivity

Based on personal viewpoints rather than clinical measurements.

A cancer patient’s self-reported fatigue may not always correlate with biomarkers but is still critical for treatment decisions.

Example of PROs Subjectivity

PROs Retrospective Study

Often assessed through surveys, evaluating past health experiences.

A post-surgical patient may be asked to rate their recovery over the past 6 months, providing insights into long-term effectiveness of an intervention.

Example of PROs Retrospective Study

Standard Gamble (SG)

Measures a patient's willingness to take risks for potential full health.

A patient with chronic pain might be asked: Would you accept a 50% chance of death for a 50% chance of complete recovery?

Example of Standard Gamble (SG)

Decision Insight for SG example

If a person is willing to accept high risk for a potential cure, they place low utility on their current health state

Time Trade-Off (TTO)

Measures the amount of life expectancy a patient would trade for improved health quality.

A patient might be asked: Would you trade 10 years of life with your current condition for 5 years in full health?

Example of Time Trade-Off (TTO)

Decision Insight for TTO example

If a person is willing to give up many years for better health, it indicates low utility for their current condition

EQ-5D assesses health across five dimensions:

1. Mobility

2. Self-Care

3. Usual Activities

4. Pain/Discomfort

5. Anxiety/Depression

Coding for Responses EQ-5D-3L (3 levels)

Levels: 1 (no problems), 2 (some problems), 3 (severe problems)

Coding for Responses EQ-5D-5L (5-level version)

Levels: 1 (no problems), 2 (slight problems), 3 (moderate problems), 4 (severe problems), 5 (extreme problems/unable to do)

With 3 levels per dimension, it can describe ___ possible health states

243 (3^5)

With 5 levels per dimension, it expands to ____ possible health states

3125 (5^5)

1 QALY =

One life year adjusted for full health (utility = 1.0)

QALY is used in

cost-effectiveness analysis for healthcare interventions

Requires calculating _________ × ________ to compare treatments.

utility weight × life years

Utility Weight

Ranges from 0 (death) to 1 (perfect health), representing the quality of life associated with a condition.

Life Years

The estimated years of life the patient will experience under the given treatment

Calculate QALY:

A new treatment extends a patient’s life expectancy by 5 years, but their quality of life is estimated at 0.8 (due to mild health issues).

QALY = 0.8 * 5 = 4

This means the treatment provides the equivalent of 4 years in full health

Cost-Effectiveness Aspects:

Treatment A: Costs $50,000 and provides 4 QALYs → Cost per QALY =

Treatment B: Costs $60,000 but provides 5 QALYs → Cost per QALY =

Treatment A= $12,500

Treatment B= $12,000

Since Treatment B offers more QALYs at a lower cost per QALY, it would be considered the more cost-effective option

Implicit bias refers to

unconscious attitudes or stereotypes that affect understanding, actions, and decisions.

Characteristics of implicit bias

- Unintentional and automatic.

- Influenced by cultural and societal conditioning.

- Can impact healthcare, employment, and interpersonal interactions.

- Measured using tools like the Implicit Association Test (IAT).

Meaning of “Jim Crow”

"Jim Crow" refers to laws enforcing racial segregation in the U.S., named after a character from 19th-century minstrel shows.

Purpose of the Jim Crow Museum

- Aims to educate on historical racism through artifacts.

- Encourages discussions on race and social justice.

Background of the Jim Crow Museum

- Founded by Dr. David Pilgrim.

- Located at Ferris State University, Michigan.

- Houses historical racist artifacts for educational purposes.

"The economic Legacy of Racism" Discusses how historical racial injustices impact present-day economic disparities.

- Systemic barriers such as redlining, limited access to education, and employment discrimination have restricted wealth accumulation for Black Americans.

- Generational poverty persists due to these historical inequities.

"The economic Legacy of Racism" Examines wealth gaps caused by systemic discrimination.

- Black households, on average, hold significantly less wealth compared to white households.

- Structural factors, such as unequal access to homeownership, banking, and investment opportunities, contribute to these disparities.

"The economic Legacy of Racism" Advocates for reparations as a form of addressing racial inequalities.

- Dr. Darity argues that direct financial compensation and policy-driven solutions (e.g., education funding, housing assistance) could help bridge racial wealth gaps.

- Reparations are positioned as a systemic response to historical injustices rather than individual support programs.

Full Name of HeLa Cells

Henrietta Lacks' cells.

Named after the woman whose cancerous cells—taken without her consent—became the first immortal human cell line.

Contributions to Genetics & Science: First immortal human cell line used widely in research.

Unlike normal human cells that die after several divisions, HeLa cells continuously replicate, making them invaluable for research.

Contributions to Genetics & Science: Played a crucial role in cancer research, vaccine development (e.g., polio vaccine), and gene mapping.

- HeLa cells have helped scientists understand cancer cell behavior, leading to advancements in treatment and drug development.

- Scientists used HeLa cells to explore human genetics, including DNA replication, chromosomal abnormalities, and cell cycle regulation.

- Their contributions extend to areas like in-vitro fertilization and HIV/AIDS research

Profit from HeLa Cells

o Many biotech companies profited from selling HeLa cells without compensating Henrietta Lacks’ family.

o After Henrietta Lacks' cells were discovered to be immortal, they were widely reproduced and distributed without her family's knowledge.

o Biotech companies and research institutions sold HeLa cells for profit, fueling breakthroughs in medicine.

- Despite HeLa’s contributions to cancer research, virology, and gene therapy, Henrietta’s family never received financial compensation, raising ethical concerns about medical consent and equity in scientific advancements

First Institution to Reproduce HeLa Cells:

o Johns Hopkins University was instrumental in HeLa cell replication for widespread medical use.

- The cells were initially shared freely among scientists but later became commercialized, leading to discussions on biomedical ethics and patient rights