Untitled Flashcards Set

Affordable Care Act (ACA)

• Use of expensive medical technology and prescription drugs

• Reimbursement systems that reward the volume of medical services instead of outcomes

• Inadequate preventive services

• The aging of the population

• Increased prevalence of chronic disease (a disease that is long in duration, reoccurs frequently, and progresses slowly)

• High administrative costs

Wide differences in access to health care or quality of health care based on where one lives as well as income, educational level, race, ethnicity, gender expression, or sexual orientation.

The number of individuals who have gained access to health care with the implementation of the ACA.

• In 2008 - 17% of the population was uninsured

• In 2017 - 10% of the population was uninsured

Medicaid

• Non-elderly adults with income below 200% of the Federal Poverty Level (FPL) who work for an employer that doesn’t provide health insurance 

  • The Federal Poverty Level is a measure of income level issued yearly by Health and Human Services used to determine eligibility for Medicaid, the Children’s Health Insurance Program, and the cost of health insurance purchased through Health Exchanges)

• Those who are unable to buy insurance because of the cost of premiums

• Hispanic, American Indians/Alaskan Natives, and those living in the South and West - in states that did not expand Medicaid

• Providers (physicians, nurses, and other healthcare workers)

• Hospitals

• Outpatient clinics

• Home-care services

Improve both the quality of care and efficiency as a result of the ACA.

Industrialization and crowded living conditions in cities

• Improper sewage disposal - resulted in contaminated water

• Lack of refrigeration - resulted in contaminated food

• Illness caused by infectious agents - accounted for one-third of all deaths with children under five years of age accounting for 40% of all deaths

• Pneumonia

• Tuberculosis

• Diarrhea

• Diphtheria

• The discovery of microbes as the cause of infectious diseases (illness caused by pathogenic viruses, fungi, or bacteria and transmitted by person-to-person contact or through a vector such as an infected mosquito).

• The development of antibiotics that were effective in treating bacterial infections such as pneumonia and tuberculosis.

Improvements in sanitation and hygiene, supported by home and workplace improvements and attempts to improve the environment

• Cities developed systems for safeguarding the milk, food, and water supply

• Health departments began to grow, applying case findings and quarantines with good results

• Better personal hygiene (handwashing) accounted for approximately one-fifth of the reduction in mortality 

• Improvement of nutrition led to an increase in the resistance to diseases

Chronic conditions

An adequate diet 

• Nutritional status is a critical factor in a person’s response to infectious diseases, especially young children. 

• Better surgical techniques

• New treatment methods

• New tests to facilitate accurate diagnoses

• Treatment of individual diseases

1940s

The arrival of antibiotics

1950s

The implementation of childhood universal vaccination

• A public health program to prevent communicable diseases through vaccination programs for children, adolescents, and adults.  

  • Immunization programs for children have eliminated most childhood infectious diseases such as measles, mumps, rubella, meningitis, hepatitis A and B, and polio.

  • Adult immunizations prevent bacterial pneumonia, shingles, and influenza.

Disease

Reason for the Decrease in Death Rate

Heart Disease

New drugs to control risk factors for heart disease (hypertension, cholesterol, and diabetes) - reduced the death rate by 16% between 2007 and 2017

Cancer

Fewer people smoking and advances in early detection and treatment - reduced the death rate by 29%

Human Immunodeficiency Virus (HIV)

The introduction of antiviral therapy in the 1990s - reduced the death rate by 80%

• Heart Disease 

• Cancer

Evaluate and develop health policy and allocate resources

78 years old 

• Unintentional injuries

• Alzheimer’s disease

• Suicide

• Chronic liver disease

Opioid use disorders - a mental illness and brain disorder caused by addiction to drugs used to relieve pain such as morphine and synthetic opioids (hydrocodone, oxycodone, fentanyl, methadone, etc.)

“Deaths of despair” or markers for complex socioeconomic problems manifested in behavioral health problems such as excessive use of alcohol or addiction to opioids.

• Suicide is among the top 5 leading causes of death for people 1-44 years old

• Chronic liver disease caused by excessive alcohol intake has increased in men

• Communities with limited opportunities for employment and the ready availability of synthetic opioids to treat pain contributed to opioid addiction

• Inappropriate opioid prescribing

  • The sale of prescription opioid painkillers nearly quadrupled from 1999 to 2014 in response to more effectively treat patients with pain.

• Aggressive trafficking of heroin, often laced with fentanyl, a highly potent synthetic opioid.

• Educating healthcare providers on appropriately prescribing opioids for the treatment of pain

• Educating patients on proper disposal of unused opioids

• Increasing patient access to medication-assisted treatment (methadone treatment programs) and behavioral health treatment programs

• The medication naloxone (Narcan) is now available to reverse opioid overdose to prevent death

• Race

• Geography

• Socioeconomic Status

  • Non-Hispanic Black mothers and American Indians/Alaskan Natives had the highest infant mortality rate, nearly twice the rate of Asians

  • Death rates of Hispanic and White infants were similar between 2000 and 2017

• Congenital malformations

• Preterm birth

• Low birth weight

• Sudden infant death syndrome (SIDS)

• Maternal complications of pregnancy

• Unintentional injuries or accidents

• Disparities in access to health care (health insurance, primary care providers, child care, and transportation)

• Lack of opportunities to obtain necessary resources such as healthy food, prenatal vitamins, and safe housing

  • Living in a rural area limits access to health care because of the growing shortage of providers, hospitals closing, and fewer physicians that specialize in pregnancy and postpartum care

Chronic diseases (conditions that last one year or more and require medical attention, limit activities of daily living, or both), such as heart disease, cancer, and diabetes, as well as degenerative diseases associated with aging.

• Those above 65 often have multiple chronic conditions (50% had 2 to 3 conditions and 15% had 4 or more).

• Treatment for these conditions accounts for two-thirds of total healthcare costs in the U.S.

• Physical activity

• Eating habits

• Smoking

• Drinking alcoholic beverages

• Using illicit drugs

• Personal hygiene

Issue

Concerns

Teens Smoking/ Tobacco Use

Possible harm to the developing teen brain and increased likelihood of lifelong addiction

Smoking During Pregnancy

Increases the risk of an infant being born too early or too small as well as birth defects including cleft lip and collect palate

Childhood 

Obesity

Children who are obese are more likely to develop chronic health problems (asthma, sleep apnea, joint problems, and type 2 diabetes) which often continue through adulthood with greater risk for heart disease

Immunizations and cancer screening (mammography and colonoscopy)

Most Common Viral Infection

Viral Gastroenteritis - an infection of the digestive tract caused by a virus transmitted between individuals. The most common cause is the norovirus with symptoms of vomiting and diarrhea

Most Common Bacterial Infection

Salmonellosis - an infection with a bacterial called Salmonella, which live in the intestinal tracts of animals, 

Coronavirus (COVID-19) 

• First identified as an epidemic in China initially linked to a large seafood and animal market, was later classified as a pandemic because it spread across several countries and affected large numbers of people.

• It was so deadly because it is easily transmitted through aerosol droplets spread by coughing, sneezing, and talking and because the virus is unlike other flu viruses for which there are vaccines

Ebola

• A deadly viral infection that is transmitted to humans by an infected animal (bat or nonhuman primate) or a sick or dead person infected with the virus.

• It was spread from West Africa to the U.S. by healthcare workers employed in West Africa and in response, the CDC developed infection-control measures to prevent further spread in Africa.

Avian (Bird) Influenza

• Identified in Europe and China; in the U.S., entire commercial poultry flocks required removal of infected turkeys and chickens to prevent further spread of disease

• Virus occurs naturally in wild aquatic birds and is easily transmitted to domestic birds; however, transmission from birds to humans is rare

Methicillin-Resistant Staphylococcus Aureus (MRSA)

• A virulent or antibiotic-resistant bacterial strain present in hospitals, nursing homes, child-care facilities, schools, and athletics programs.

• Can cause skin infections after a cut or abrasion and increases the risk for surgical infections, pneumonia, and sepsis in hospitalized patients.

• Strict infection-control measures are needed to prevent the spread of the bacteria since it is resistant to antibiotic treatment.

• Lack of needed personal protective equipment (PPE) such as masks, gloves, and gowns for healthcare workers

• Lack of a quick and reliable test to identify those infected

• Slow response because of a growing public skepticism of science and scientists at the National Institute of Health (NIH) and the Centers for Disease Control and Prevention (CDC)

A team of public health experts to track and contain diseases to prevent epidemics in both humans and animals. 

• Physicians, nurses, veterinarians, medical laboratory technologists, epidemiologists, and public health officials at the local, state, and federal levels are examples of healthcare workers involved in preventing the spread of infectious disease.

• CDC - coordinates healthcare workers at the city and state level

• WHO - international governmental agency responsible for coordinating healthcare workers

• Handwashing and self-isolation for those who are infected

• Advances in medical technology have improved survival rates of trauma victims and the severely ill

• Clinical developments, such as infection control, less invasive surgical techniques, and advances in reproductive technology, improve the quality of life.

• Drug therapy for managing chronic conditions has extended life 

• More prescription drugs are being developed and used to treat chronic disease

Type of Computer Technology

Description of Computer Technology

Augmented Intelligence (Artificial Intelligence - AI)

• The use of computers and technology to simulate intelligent behavior and critical thinking comparable to a human being

• Can sort through data in public health settings to predict the spread of infectious diseases or to assist a healthcare provider in making decisions about the best medication to use for a specific patient based on symptoms, chronic health problems, and other medications

Health Information Technology (Health IT)

• The use of computers to store health data to support health information management across computerized systems and the secure exchange of health information among providers, consumers, and payers

Subtype

Examples of the Subtype

Virtual AI

• Electronic Health Record (EHR) systems or computer-assisted analysis used by radiologists to identify abnormal X-rays or magnetic resonance images (MRIs)

Physical AI

• The use of robots to assist in performing surgeries using 3D images and magnification.

• Sensors to track the movements of patients

• Remote monitoring of patient clinical data (blood pressure, blood glucose, or heart monitoring)

• Make it possible for multiple team members to schedule a patient-team conference regardless of physical location

• Sharing of EHRs among different providers for the same patient

• Has the potential to improve patient safety by preventing drug interactions and reducing costs by avoiding duplicate lab tests

• Patients can access their EHR to view important information about their chart

• Hospitals can use it to monitor hospital-acquired infections

• The federal government uses the data to monitor outcomes (hospital readmission rates and surgical complications as well as healthcare costs

• Can prolong life for the critically ill, unresponsive patient who has little or no chance of recovery

• For the healthcare system, dying can be extremely expensive

• Raises ethical concerns for patient privacy and security to prevent data breaches

• Start-up costs may be prohibitive for small group practices

• High cost of technology affects the financial structure of the healthcare system 

• Limits in funding means advancement treatment is not available to everyone (poor people who need it most, have no access)

Less time spent learning personal, non-technical aspects of care

• This value system is reinforced by professionals, peers, administrators, and the public

• Dominates the healthcare system by virtue of its expanding monetary support of technology and services and because it sets the rules for the provision of health care.

The Human Genome Project

Autism Spectrum Disorders (ASD) - A group of developmental disabilities that can cause significant social, communication, and behavioral challenges.

• Children with ASD are treated by a team of health professionals, including occupational therapists, speech therapists, and applied behavior analysis (ABA) therapists.

• Alzheimer’s Disease

• Parkison’s Disease

• Epilepsy

• Autism Spectrum Disorder (ASD)

• Psychiatric Disorders (schizophrenia and depression)

Nonmedical Factors - Social Determinants of Health

Lack of access to:

• Stable housing

• Nutritious food

• Employment

• Education

• Personal safety

• Reliable transportation

Category

% of Health Outcomes

Examples 

Health Behaviors

30%

• Tobacco Use

• Diet and Exercise

• Alcohol and Drug Use

• Sexual Activity

Clinical Care

20%

• Access to Care

• Quality of Care

Social and Economic Factors

40%

• Housing

• Food

• Education

• Employment

• Income

• Family and Social Support

• Community Safety

Physical Environment

10%

• Air and Water Quality

• Housing and Transit

Value-Based Care - paying for the quality of care rather than the quantity (number of procedures) for Medicare patients.

Reasons for High Hospital Readmission Rates

• Unmet social needs (social determinants) homelessness, food insecurity, or access to transportation

Characteristics of People with Higher Readmission Rates

• Racial and ethnic minority

• Limited English proficiency

• Low health literacy

• Disability

• Lack of a primary care provider

What is Being Done to Prevent Frequent Hospital Readmissions

• Identifying unmet needs of patients before hospitalization and using a team approach before hospital discharge

• Identify barriers that prevented patients from making clinic appointments

• Providing financial incentives for hospital staff to schedule follow-up clinic visits

• Provided transportation and a $20 gift card after the visit

• Reduce healthcare costs through the Better Health Through Housing program (reduce healthcare costs and provide stability for the chronically homeless by moving individuals directly from hospital emergency rooms into stable, supportive housing)

• American Hospital Association (AHA)

• American Academy of Family Physicians (AAFD)

Health disparities 

Equality

Treating everyone the same even though not everyone starts at the same place.

Equity

Everyone has a fair opportunity to be as healthy as possible (removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care)

Addressing inequities in health care requires that each community examine the underlying causes and barriers to equal opportunity for all citizens, including poverty, high unemployment, low educational achievement, high crime rates, and availability of affordable health care.

• The Centers for Medicare and Medicaid (CMS) has allowed Medicaid health plans to cover the cost of nonmedical services such as food and transportation

• The County Health Rankings and Roadmap Model includes resources to examine communities and develop action plans for changing the local environment 

What Needs to be Done?

• Collect data on all components of health

• Document trends in risk factors, health status, and access to and utilization of healthcare services

• Disseminate reliable and accurate information about the health of our population

• Gain an understanding of the healthcare need and utilization patterns of population subgroups

Why is it Necessary?

• Enable policymakers to set program priorities and allocate target resources most effectively