HMP 310 Midterm

camden coalition summary

two buildings (nursing home & apartments with elderly and disabled people) are the most expensive healthcare costs; in camden, NJ, dr. brennar put a team of hot spotters through small grants to employ nurses, social workers, and medical assistants to find out the reasons behind why a patient visits the ER so much and to prevent them from visiting hospitals (ex. hire a contractor to redo house where patient suffers from asthma)

hotspotting

is a practice where providers identify very high-cost patients and attempt to reduce their medical spending while improving care, often in non-traditional ways (e.g. linking to social workers or providing housing)

1, 30

___% of camden, NJ's residents made up ___% of the city's healthcare costs

social, economic

many of the highest cost patients suffer from ___________ or __________ issues that prevent them from getting appropriate care

camden coalition

provides high-quality coordinated primary care, including at-home visits from nurses ; employs social workers to help connect patients to other social services (addiction treatment, housing, unemployment, etc.); works to understand underlying causes of repeat hospitalization and help patients overcome them

no

does hotspotting work?

aging population, chronic diseases, insurance incentives

why is population health growing in importance? (hint: ++__________

population health

seeks to improve health outcomes of a group by identifying individuals within this group

taking care of people from beginning to end

attempt to put a new type of insurance framework around something that we haven't figured out if people want it or not

12, 44, 20

___% of the population 65+ consumes over ___% of healthcare costs, and within 14 years, the population will bloom to ___%

kindig's definition of population health

the health outcomes of a group of individuals, including the distribution of such outcomes within the group; includes health outcomes, patterns of health determinants, and policies and interventions that link the two

two critiques of population health definition

1. defining and measuring concepts of health are large

2. concept is broad enough to include everything

chronic care management, quality & safety, public health, health policy

four pillars of population health

chronic care

first pillar of population health; includes an interprofessional team of healthcare providers and prevention efforts

quality & safety

second pillar of population health; includes system training, organization workflows, and assessments

public health

third pillar of population health; includes epidemiologists, environmental health professionals, and health administrators

health policy

fourth pillar of population health; includes researchers, policymakers, and legislators

financial incentives

population health improvement will not be achieved until appropriate ______________ ___________ are designed for this outcome

five necessities to improving population health

1. elaborated business model

2. money for community financial analysis

3. "policy packages"

4. dependable revenue strings

5. IOM roundtable on improvement strategies

2014

when did life expectancy start to decrease in the US

government

who is the largest provider of health care funds?

hospitals

who is the largest user of healthcare funds?

link and phelan paper summary

argued that researchers focus on proximate risks like weight, smoking status, and exercise to reduce health risks; however, risk factors change from one period to another, while socioeconomic status remains the same even as risk changes

social conditions

factors that involve a person's relationships to other people, including positions occupied within the social and economic structures of society

link and phelan

who argued that social status is a fundamental influence on health because, regardless of risks, people with more resources, information, power, and useful networks are better able to take advantage of what is known about preventing disease and maintaining health?

increase

any new health opportunity that gives unequal access to an advance will initially _______ health disparities

universal, compensate

link and phelan believe we should seek more __________ interventions that depend less on an individual's resources or __________ the most disadvantaged through targeting efforts

designing safer road systems, fluoridating water, and providing healthy foods in public schools

which policy is more useful using the link and phelan approach:

designing safer road systems or teaching people about safe driving habits

fluoridating water or encouraging better tooth brushing and flossing

3. providing healthy foods in all public schools or encouraging healthy eating habits?

processes

efforts to reduce risk changing behavior may be ineffective if there is no understanding of the __________ that lead to exposure

interventions, disease, skeptical

link and phelan suggest policymakers should:

1. require all __________ contain an analysis of factors that put people at risk

2. consider if intervention has an impact on one ___________ or multiple

3. be ____________ about interventions that focus on intervening variables but claim to address a broader social condition

healthy people

sets the country's health-promotion and disease-prevention agenda over 10 year periods

department of health and human services

which department launched healthy people in 1979?

down

the healthy people 2030 program has gone __________ since 2020

specific

the healthy people program has gotten more __________ goals over time

social determinants of health

conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks

place

healthy people 2030 uses a __________-based approach to social determinants of heath

five domains of social determinants of health

education access & quality, health care access and quality, economic stability, social and community context, and neighborhood and built environment

education access and quality

one of the five domains of social determinants of health that includes early childhood education & development, enrollment in higher education, high school graduation, and language and literacy

health care access and quality

one of the five domains of social determinants of health that includes access to health care, primary care, and health literacy

neighborhood and built environment

one of the five domains of social determinants of health that includes access to healthy foods, crime and violence, environmental conditions, and quality of housing

social and community context

one of the five domains of social determinants of health that includes civic participation, discrimination, incarceration, social cohesion

economic stability

one of the five domains of social determinants of health that includes employment, food insecurity, housing instability, and poverty

leading health indicators (LHIs)

selected high priority issues broken up by age group to be studied

world health organization

which organization has broader social determinants that encompass global issues

whitehall study

a study focused on british civil servants and showed a clear, steep inverse relationship of social class & mortality rate and no "leveling off" effect seen

hispanic

which race had the highest life expectancy at birth between 2006-2016?

black

which race had the lowest life expectancy at birth between 2006-2016?

black

which race has the highest infant mortality rates in the US?

pulmonary embolism

what is the leading cause of death during childbirth?

false; wealth and education status alone does not account for disparities in life expectancy

true/false: being poor or having a low education status ensures a low life expectancy

white

which race do doctors usually not perceive as drug-seeking when requesting pain relief?

black

which race are physicians twice as likely to underestimate pain in?

tuskagee syphilis experiment

infamous clinical study conducted between 1932 and 1972 by the US public health service o study the natural progression of untreated syphilis in rural black men who thought they were receiving free health care from the US government

"bad blood"

what the men in the tuskegee study were told what they were being treated for

$9 million payout, national research act signed to prevent other unethical research, bill clinton apologizes

what three things happened as a result of the tuskegee experiment?

medical mistrust

older black men had an increase in __________ __________ and mortality and a decrease in physician interactions after the tuskegee study

white men

historically, which group were clinical trials conducted on the most?

dosage

when clinical trial drugs launched in other countries, what kind of unanticipated issues arose?

japan

the pharmaceuticals and medical devices agency (PMDA) was founded in __________ to explain the importance of dosage in japanese subjects

joint statement of 3 ministers meeting

health ministers of korea, china, and japan met to affirm significance of cooperation on clinical research, including clinical trials, especially with regards to clarifying how ethnic factors impact clinical data

1/3

what fraction of new drugs approved by the PDMA have lower standard dosages in the US and europe than japan?

potential to harm pregnant woman and their babies; they do not have hormonal cycles

why were all clinical trials done on men (2 reasons)?

false

true/false: clinical findings in men would hold for women

less

men are __________(more/less) likely to experience barriers to care due to cost

affordable care act

which act prohibited gender discrimination in healthcare premiums, prohibiting women from paying more for healthcare coverage?

social (stereotypes, beliefs, and norms of masculinity)

__________ barriers may prevent men from seeking medical services

higher

in the US and globally, men have __________rates of alcohol, tobacco, and drug use

woman

depression and anxiety affect __________ the most

4 reasons why depression and anxiety are more common in women

1. higher poverty rates

2. higher rates of domestic abuse/sexual violence

3. increased caregiving responsibilities

4. postpartum & pregnancy related disorders

deaths of despair

deaths from suicide, drug overdose, alcohol-related liver disease, etc. among working class white americans

case and deaton

which two researchers said that a substantial cause of the rise in white, middle-aged mortality was due to increases in deaths from suicides and drugs (deaths of despair)

high school, bachelor's

deaths of despair is increasing rapidly in populations with a __________ __________ degree or less. there is only a slight increase amongst populations with a __________ degree or more

household

deaths of despair are somewhat correlated to a declining __________ income

the poor that live in affluent areas

the gap in life expectancy between the wealthy and poor is growing, but which group of the poor live longer than other poorer americans?

increasing

the chetty et al. study finds that life-expectancy gaps between the rich and poor have been ___________ in recent years

increasing

chetty et al. study finds that life expectancy gaps have been __________ between the rich and the poor in recent years

practice style

variation in spending is largely due to __________ __________

california, new york, vermont

three states with the highest life expectancies

rust belt

region of the US with the lowest life expectancies

health behaviors and community factors

what two things are predictive of life expectancy?

access to medical care, environmental differences, inequality, and unemployment

what four things are not predictive of life expectancy that researchers thought would be?

dartmouth atlas

documented variations in medical resource distribution and spending using medicare data

no

is variation in spending a bad thing?