MR. MARC ONEEL C. ALVAREZ, RN, RM, MAN Mr. Marc Oneel C. Alvarez, RN, RM, MAN.
-
Upload
rhoda-fitzgerald -
Category
Documents
-
view
215 -
download
0
description
Transcript of MR. MARC ONEEL C. ALVAREZ, RN, RM, MAN Mr. Marc Oneel C. Alvarez, RN, RM, MAN.
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
MR. MARC ONEEL C. ALVAREZ, RN, RM, MAN
Chapter 7 – MEDICAL MANAGEMENT IN
POPULATION HEALTH CARE
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
VALIDITY VERSUS RELIABILITY
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
CLINICAL EFFECTIVENESS Appropriate use of CLINICAL RESOURCES: TESTS and TREATMENT Guide question:
1. Are the test accurate?2. Are the resources used appropriately?3. What is the impact of testing information?4. What is the diagnostic ability of the tests?
INDICATORS OF TEST PERFORMANCEACCURACY- condition of being true, correct or exactEFFICACY - is the capacity of producing a desired result or effect (effectiveness)EFFICIENCY – is the ability to accomplish a job with a minimum expenditure of time and effort.
MEDICAL MANAGEMENT
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
Constructs that measures the ACCURACY OF A TEST. Quantified by the parameters known as sensitivity, specificity and predictive values
1. VALIDITY
Test Results
Disease (D) No Disease (NoD)
Totals
T+a
TP
b
FP
a + b
T-c
FN
D
TN
c + d
Totalsa + c b + d a + b + c + d
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
Sensitivity = a/(a+c) Specificity = d/(b+d) Predicitive Value + = a(a + b) Predicitive Value + = a(a + b)
Validity by 2 x 2 Contingency Table
Test Results
Disease (D) No Disease (NoD)
Totals
T+a
TP
b
FP
a + b
T-c
FN
D
TN
c + d
Totalsa + c b + d a + b + c + d
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
TEST Description
SENSITIVITYa/(a+c)
ability of a test to correctly identify individuals who have a disease.
Ratio of TRUE POSITIVES to the Individuals WITH THE DISEASE
TEST FOR ACCURACYSPECIFICITYd/(b+d)
Ratio of TRUE NEGATIVES to the Individuals WITHOUT THE DISEASE
measures the number of individuals without the disease that test correctly identifies as NEGATIVE for the disease
TEST FOR ACCURACY
Sensitivity and Specificity are test for accuracy. Absolute Value range from 0 to 1. The nearer the value to 1 means the test is more ACCURATE
Test Results Disease (D) No Disease (NoD) Totals
T+a
TPb
FP a + b
T-c
FND
TNc + d
Totalsa + c b + d a + b + c + d
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
TEST Description
PREDICTIVE VALUE OF A (+) Test Resulta/(a+b)
Measures the Number of individuals with a POSITIVE TEST result who actually have the disease
PREDICTIVE VALUE OF A (-) Test Resultd/(c+d)
Measures the proportion of test negatives that were correctly identified by the test as NOT having the disease
Test Results Disease (D) No Disease (NoD) Totals
T+a
TPb
FP a + b
T-c
FND
TNc + d
Totalsa + c b + d a + b + c + d
a.) Increase in Prevalence of the Disease = Increase in the Positive Predictive Value and Decrease in the Negative Predictive Valueb.) Decrease in Prevalence of the Disease = Decrease in the Positive Predictive Value and Increase in the Negative Predictive Value
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
VALIDITY PARAMETERS FOR ATHRITIS SCREENING TESTS WITH A PREVALENCE OF 10 %
Test Results ARTHRITIS NO ARTHRITIS Totals
T+ 264 180
444
T- 136 3420 3556
Totals400 3, 600 4000
SENSITIVITY
SPECIFICITY
PREDICTIVE VALUE (+)
PREDICTIVE VALUE (-)
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
VALIDITY PARAMETERS FOR COLORECTAL CANCER SCREENING TESTS
Test Results COLORECTAL CA NO COLORECTAL CA Totals
T+ 18 99
117
T- 2 1881 1883
Totals20 1,980 2000
SENSITIVITY
SPECIFICITY
PREDICTIVE VALUE (+)
PREDICTIVE VALUE (-)
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
Predictive Validity of a PREADMISSION SCREENING TEST Test whether pre-admission screening test to Home care is accurate
MANAGERIAL ASPECTS OF VALIDITY
Test Results COLORECTAL CA NO COLORECTAL CA Totals
T+ ( Eligible for admission)
A B
A+B
T- ( Not Eligible for admission)
C D C+D
TotalsA+C B+D A+B+C+D
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
Degree to which repeated observations result in similar result on the same individual, under the same conditions.
Often referred to as PRECISION, REPRODUCIBILITY, REPEATABILITY Important in diagnostic and therapeutic testing Causes of VARIATIONS:
a. IMPROPER CALIBRATION OF MEASURING INSTRUMENTSb. Observer-based variationc. Temporal changes in the subject/person (BP)
RELIABILITY INDEX - used to identify Level of acceptable Variation
2. RELIABILITY = (a+d) / (a+b+c+d)
Observer 1 T + Observer 2 T - Observer 2 Totals
T+a b a + b
T-c D c + d
Totalsa + c b + d a + b + c + d
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
RELIABILITY INDEX OF 2 PATHOLOGISTS TESTING THE WBC MORPHOLOGY
Observer 1 T + Observer 2 T - Observer 2 Totals
T+25 20 45
T- 18 137 155
Totals43 157 200
RELIABILITY = (a+d) / (a+b+c+d)
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
MANAGING CHRONIC DISEASES
DISEASE managementSpecific
program of care
Specific program of care
Measuring clinical otcome
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
CONTRACTED CARVE-OUT> provision of care to the client by contracting with Disease Management
Companies
PRIMARY CARE MODEL> focuses on specialized teamwork within HMO’s and other comprehensive health
care systems that assist primary care providers in caring for chronically ill patients.
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
MANAGING INFECTIOUS DISEASES
Patients to Patients
Between Patient and Health Care
workers
Between Healthcare workers
Nosocomial Infection
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
Pathogenicity Ability of the infectious agent to cause DETECTABLE disease
= Total persons with Clinical Disease x 100 Total Infected Individuals
Infectivity Ability of the Infectious Agent to invade and multiply in a host
The minimum number of Infectious Agents in half of the group of Individual hosts
Virulence Severity of infection and can be defined as the proportion of cases of clinical diseases that result in severe disease r death
AKA as Case Fatality Rate= Total Death of the Disease Total infected individuals
INFECTIOUS DISEASE EPIDEMIOLOGY
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
Infectious epidemics
ATTACK RATE Coincides with the generation time (acquisition of the agent up to its max. time of communicability)
= Number of new cases or condition (during the epidemic period) TOTAL Susceptible persons (during epidemic period)
SECONDARY ATTACK RATE
Number of new cases of a disease or condition that develop after the epidemic has ended YET are related to the EPIDeMIC
Mr. Marc Oneel C. Alvarez, RN, RM, MAN
Question?