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HCMG 1010, Exam 2
Quality in Health Care
| Question | Answer |
|---|---|
| What are ways of tracking quality that make it vulnerable to cream skimming or patient selection? | mortality rates, readmission rates |
| What are process-of-care measures? | Random assignment of patients to hospitals or doctors to ensure they cannot be manipulated by cream skimming |
| How were beta blockers related to process measures? | Beta blockers showed that they saved lives with a randomized trial, but only 60=70% of patients received beta blockers in 2002 after trial |
| What is the best gap across process measures and why? | Cataract, 70% of recommended care was delivered because ophthalmologist offer cataract surgery if appropriate criteria are met, visual impairment reported leads to complete eye exam |
| What is the worst gap across process measures and why? | Alcohol dependence, assessment of dependence is 8.7% recommended and referral for treatment is 4.6% |
| What is a social factor that negatively affects percentage of recommended care received | income |
| What are two fundamental barriers to organizational innovation in healthcare? | lack of good information on quality, difficulty measuring quality also makes expansion of high-quality firms more difficult |
| What is the population group in the natural experiment that explained whether quality vary across physicians? | unnamed VA hospital has two academic affiliates, one set of physicians is affiliated with a top medical school. the other set of physicians is affiliated with a middle-of-the-pack medical school. |
| What ensured equitable distribution of cases in the natural experiment that explained whether quality vary across physicians? | patients with SSN ending in odd number were assigned to Program A, those with an even SSN assigned to Program B |
| What were key findings from the natural experiment that explained whether quality vary across physicians? | Those treated by physicians from top-ranked programs had shorter and 10-25% less expensive hospital stays, lower ranked programs tend to order more diagnostic testa and take longer to order them |
| What does quality mean? | delivering the "right" care |
| What does safety mean? | avoidance of harm (including near misses) |
| What does negligence man? | Act or omission by that deviates from accepted medical standard of care, results in adverse outcome, leads to harm and malpractice |
| What are the types of medical errors? | diagnostic, treatment, preventative |
| What are types of diagnostic medical errors? | error in delay in diagnosis, failure to employ indicated tests, use of outmoded tests or therapy, failures to act on results of monitoring or testing |
| What are types of treatment medical errors? | performance of an operation, administering the treatment, dose of using a drug, avoidable delay in treatment or responding to abnormal test |
| What are types of preventative medical errors? | failure to provide prophylactic treatment, inadequate monitoring or follow-up of treatment |
| Why is it hard to for low productivity producers like physicians to be shaken out by normal competitive forces? | cannot rely on market forces, therefore role for punishing poor quality is medical malpractice |
| What are the requirements for a medical liability cse? | legal duty on the part of the doctor to provide care or treatment to the patient, treating doctor fails to adhere to the standards of the profession, breach of duty led to injury, damages from the injury |
| What are the objectives of the medical malpractice system | compensate the victims (economic and non-economic), deter future negligence |
| What are the challenges to the medical liability system? | not very well targeted, most malpractice does not result in a claim, criticized for leading to "defensive medicine", driving up costs |
| What is "defensive" medicine? | When doctors orders stuff or avoid certain high-risk patients or procedures primarily because of concern about malpractice liability |
| What is an economic definition of "defensive" medicine? | spending that exceeds the socially optimal amount due to concerns about malpractice liability |
| How is defensive medicine related to procedures? | defensive medicine occurs when a doctor conducts procedures in order to protect herself against litigation, on reason for unnecessary procedures being performed |
| What is tort | a civil wrong that causes a claimant to suffer loss or harm, resulting in legal liability for the person who commits the tortious act |
| What is tort reform? | proposed changes in the civil justice system that aim to reduce the ability of victims to bring tort litigation or to reduce damages they can receive |
| What is one assumption used when making tort reform? | reducing a physician's risk of liability will either reduce unnecessary procedure use or have no effect |
| What is one complicating factor when making tort reform? | financial considerations can also sway physicians to perform unnecessary procedures |
| What is the context to Frakes and Gruber military experiment? | natural experiment - active duty military receiving treatment from military facilities do not have recourse if suffer from negligent care, but military personnel can also get private care outside of military bases; dependents treated on base can sue |
| What are the experimental factors in the Frakes and Gruber military experiment? | results in two groups of similar people with varying liability for doctors, use closings of base hospitals, shift everyone to private care where doctors are not immune from liability |
| What were the statistical findings from Frakes and Gruber military experiment? | reduces overall inpatient spending by 5% but increases use of C-sections by 4% |
| What were the conclusions drawn from Frakes and Gruber military experiment regarding protection from being sued? | protection from being sued can increase unnecessary procedure use if doctors are performing procedures in marginal cases |
| What were the conclusions drawn from Frakes and Gruber military experiment regarding tort reform? | effects of defensive medicine likely vary; tort reform may push doctors toward more or less treatment, tightly linked with financial incentives |
| What is an alternative explanation for unnecessary procedure use? | physicians more likely to perform unnecessary procedures when they profit from them |
Created by:
goldengalleon