Chapter 16- Outcomes Research
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| What factors are contributed to the emergence of outcomes research? | 1 the need for cost containment in the health care sector, 2 the need to examine outcomes other than mortality, such as health-related quality of life, 3 the need to determine "best practices" and reduce the great variation in health care that occur
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| What is the purpose of outcomes research? | efficacy and effectiveness
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| How is efficacy defined? | as the effect of treatment delivered under carefully controlled conditions; "does it work? is it safe?"
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| How is effectiveness defined? | as the usefulness of a particular treatment to the individuals receiving it under typical clinical conditions
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| What are some of the frameworks for outcomes research? | the Nagi model (disablement model), the International Classification of Impairments, Disabilities, and Handicaps, the International Classification of Functioning, Disability, and Health
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| What does the Nagi model describe? | active pathology, impairment, functional limitation, and disability
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| What does the International Classification of Impairments, Disabilities, and Handicaps describe? | the long-term abnormality of disease as impairments, disabilities, and handicaps
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| What does the International Classification of Functioning, Disability, and Health describe? | changes in body functions or structures, activities, participation and disability
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| What are the different measurement tools for outcomes research? | self-assessment and quality of life
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| What issues need to be considered when developing a self-assessment tool? | 1 construct definition, 2 target population and 3 anticipated use of the scale; must meet criteria for validity
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| How is quality of life defined? | a global concept that can include elements as diverse as perceptions of health, satisfaction with the work environment, quality of family and social relationships, satisfaction with schools and neighborhoods, productive use of leisure time, etc
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| How is health-related quality of life measured? | measures of HRQL should include elements related to physical, psychological, and social functioning
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| What does the Short Form-36 define? | 1 role limitation caused by physical problems, 2 role limitation cause by emotional problems, 3 social functioning, 4 mental health, 5 pain, 6 energy, 7 fatigue, 8 general health perceptions
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| How is the Sickness Impact Profile used? | to evaluate the physical dimensions of ambulation, mobility, and body care; the psychosocial dimensions of social interaction, communication, alertness, and emotional behavior; and other dimensions related to sleep/rest, eating, work, home management, etc
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| What does the Functional Status Questionnaire measure? | physical function, emotional function, social performance, and a group of other functions including sexual function, global disability, global health satisfaction, and social contacts
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| What is satisfaction? | seen as an important outcome of treatment, as well as an indicator of the effectiveness of various structures and processes within the health are system; may be related to clinical outcomes if it affects appointment-keeping and adherence to treatment
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| What are some of the databases used in outcomes research? | medical records, abstracts of medical records, insurance claims databases, in-house databases, natinoal outcomes databases
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| What are some of the advantages to medical records? | they contain a great deal of information that can be evaluated in context
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| What are some of the disadvantages to medical records? | reviewing is time-consuming, information may be inconsistent and incomplete
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| What are some of the advantages of using abstracts of medical records? | time efficient
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| What are some of the disadvantages of abstracts of medical records? | may be errors in coding the information, including diagnoses, comorbidities, and complications; information is often less specific than desired
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| What are some of the advantages to the use of insurance claims databases? | tend to be complete because of their link to reimbursement for services, offer access to large numbers of patients at low cost
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| What are some of the disadvantages of insurance claims databases? | limitations on the number of diagnoses, comorbidities, and procedures that are listed; coding strategies may change with policy changes that may not be a change in practice; person-level changes generally not available
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| What are some of the analysis issues on outcomes research? | case mix adjustments, missing data, survival analysis, and comparisons across scales
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