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?