CPH EXAM 499 Questions with Verified Answers,100% CORRECT

CPH EXAM 499 Questions with Verified Answers Attributable risk - CORRECT ANSWER Rate of disease in exposed individuals that can be attributed to the exposure. Or the proportion of all cases that can be attributed to a particular exposure. Adjusted rate - CORRECT ANSWER Effects of differences in composition of pops being compared have been minimized by statistical methods. ex: regression analysis and strandardization -often used on rates or relative risks Ecological Fallacy - CORRECT ANSWER Bias that may occur because an association observed between variables or an aggregate level does not represent the association that exists at an individual level Confidence Interval - CORRECT ANSWER 95% confident that the true value of a variable is contained within the interval. -used to account for sampling variability -it is a point estimate +_ margin of error, where the point estimate is the best estimate of teh unknown parameter and the margin of error is the product of the confidence level and the standard error. if a 95% CI for the differences in mean does not include 0 (the null value) then there is eveidence of a statistically significant difference at sigma=0.05 Clinical Trial Phases - CORRECT ANSWER 1. Safety and Pharmacologic profiles 2. pilot efficacy studies 3. extensive clinical trials 4. after the FDA approves, look at specific effects to establish incidence of adverse reactions, etc. longterm use effects. interpretation of studies - CORRECT ANSWER temporality: cause precedes effect Specificity: important in assessing the possibility of biases. Consistency: several studies showing similar results. homogeneity statistically. Confounders - CORRECT ANSWER -non-causal association between exposure and outcome as a result of a third variable. -distortion of effect by other factors -must be related to exposure AND outcome -not an intermediate variable on causal pathway Controlling for confounders - CORRECT ANSWER before data collection: random collection, individual matching, frequency matching After data collection: direct adjustment, indirect adjustment, mantel-haenszel, regression techniques Quality Assurance vs. Quality Control - CORRECT ANSWER QA: ensure quality before data collection QC: monitor and maintain quality during study reliability vs. validity - CORRECT ANSWER R: precision, reproducibility V: accuracy, absence of bias systematic error - CORRECT ANSWER (lack of validity) if there's a difference between what is actually being estimated and what is intended to be measured. Increasing sample size doesn't help. Random Error - CORRECT ANSWER (lack of precision) occurs, but increasing sample size helps. RCT studies - CORRECT ANSWER Tests efficacy or effectiveness of healthcare services. random allocation of participants to different treatments. Includes blinding, placebo. gold standard for evidence. Community Intervention/cluster RCT - CORRECT ANSWER community-wide basis or groupwide Case-Crossover RCT design - CORRECT ANSWER -cases serve as their own control -exposure has transient effect Cross Sectional Studies - CORRECT ANSWER SNAPSHOT! at a single point in time. tells the prevalence and association. causation cannot be implied. a study that examines the relationship between diseases and other variables as they exist in a defined population at one particular time. Matching - CORRECT ANSWER used to make cases and controls as similar as possible to avoid confounding. ex: race, gender, age. +Maybe the only way to control confounding. increases statistical power, straightforward. -requires use of special analytical techniques, residual confounding can occur if you match continuous variables by category. types of matching - CORRECT ANSWER individual matching: case and control matched individually frequency matching: a group of controls Minimum Euclidean Distance measure: match to closest person. Cohort Studies - CORRECT ANSWER RISK RATIO, RELATIVE RISK, INCIDENCE RATE, RATE RATIO -rare exposures -group of subjects who shared experiences during a particular time. Determines if incidence is related to exposure. Concurrent/longitudinal cohort studies - CORRECT ANSWER starts now (with a baseline exam) and goes into future. expensive and time intensive. non-concurrent/retrospective cohort studies - CORRECT ANSWER assembled in past based on existing records. faster and quicker, but records can be limited or biased. follow up can be hard. Prevalence of disease - CORRECT ANSWER measure of the burden of disease in a community (new and existing cases). the number of events in a given population at a designated time. -obscures causal relationships point prevalence - CORRECT ANSWER -proportion of pop that is diseased during a single point of time. -at a specific point in time number of cases at a particular moment/ number in population at that moment period prevalence - CORRECT ANSWER -proportion of pop that is diseased during a specified duration of time. -during a specific period of time number of cases during a specified time period/ number in population at midpoint of period incidence of disease - CORRECT ANSWER measure of risk (new cases) the rate at which people without a disease develop the disease during a specific period of time. #of new cases over a period of time/ population @ risk of the disease in that time incidence rate (also incidence density) - CORRECT ANSWER CASES OF DISEASE/PERSON-TIME AT RISK TIME is important. -it shows greater accuracy, but is hard to calculate. -used for causal research Incidence Proportion - CORRECT ANSWER CASES OF DISEASE/PERSONS AT RISK cumulative risk/average risk the proportion of a group of people who experience the onset of a health-related event during a specified time interval. Incidence Odds - CORRECT ANSWER CASES OF DISEASE/SURVIVORS Ratio of people who experience outcome to ratio of people who no not experience outcome. Rate Ratio - CORRECT ANSWER ratio of incidence rate in the exposed group to the non-exposed group Risk Ratio - CORRECT ANSWER -measures the increased risk for developing a disease after being exposed to a risk factor compared to not being exposed to the risk factor. RR= risk for the exposed/ risk for the unexposed -often referred to as "relative risk" Odds Ratio - CORRECT ANSWER Ratio of incidence odds in exposed group to non-exposed group. [p1/(1/p1)]/[p2/(1/p2)] OR: a*d/b*c exposed not exposed cases a b controls c d Information Bias (also observational bias) - CORRECT ANSWER systematic error/flaw due to incorrect definition, measurement, or classification that results in reduced quality (accuracy) Ex: false positives/negatives or errors in death records. Differential Information Bias - CORRECT ANSWER Probability of cases vs. non-cases of misclassification is different. Non-Differential Information Bias - CORRECT ANSWER Probability of cases vs. non-cases of misclassification is NOT different. Selection Bias - CORRECT ANSWER When sample/participants aren't representative. how to avoid: control confounders and choose good comparison group. power - CORRECT ANSWER -the ability to reject the null hypothesis when the null is in fact false. -probability of detecting a difference if one truly exists. 1-beta= probability of declaring a difference not statistically significant when a difference truly exists. Type 1 Error - CORRECT ANSWER reject the null hypothesis when it is true alpha or Type 11 Error - CORRECT ANSWER fail to reject the null hypothesis when it is false beta aggregate data - CORRECT ANSWER vital stats, data from govt databases, summaries from reporting systems, production and sales data, group-level. COMBINED individual level data - CORRECT ANSWER questionnaires, medical records, national surveys, biological specimens Stages of disease prevention - CORRECT ANSWER Primary, secondary, tertiary Primary Disease Prevention - CORRECT ANSWER Prevent it from occurring (vaccines) Secondary Disease Prevention - CORRECT ANSWER Modify severity (better access to ER) Tertiary Disease Prevention - CORRECT ANSWER Rehabilitation. measures to prevent reoccurrence of disease Rate of Disease - CORRECT ANSWER how fast is the disease occurring in the population Proportion of Disease - CORRECT ANSWER What fraction of the population is affected? Case Fatality (CF) or Fatality Rate - CORRECT ANSWER Measures of the severity of disease. 9 deaths per 10,000/1 year Within a given year, out of 10,000 people diagnosed with a disease, 9 died. Secondary Attack Rate (person-to-person spread) - CORRECT ANSWER # of persons sick by the primary case/# exposed to primary case Attack Rate - CORRECT ANSWER # of people at risk who develop disease /# of people at risk Outbreak investigation steps - CORRECT ANSWER 1. define epidemic 2. look for the time-place interaction of cases 3. look for combination of variables 4. Develop hypothesis 5. Recommend control measures Common Source Outbreaks - CORRECT ANSWER groups of persons exposed to common agent Propagated Outbreaks - CORRECT ANSWER spreads gradually from person to person Mixed epidemic Outbreaks - CORRECT ANSWER both common source and person to person exposure Persistent Organic Pollutants (POPs) - CORRECT ANSWER toxic chemicals that persist in the environment for long periods of time. adverse effects on humans and animals. circulates globally. organophosphates - CORRECT ANSWER pesticides that contain phosphorus. short lived. toxic when first applied. Mutagen - CORRECT ANSWER agent that causes a permanent genetic change outside of normal growth. mutagenicity - CORRECT ANSWER capacity to cause permanent genetic change MRSA - CORRECT ANSWER bacterial strains. resistent to antibiotics. benign colonizers of the skin. may cause severe infections. Morbidity - CORRECT ANSWER rate of disease, incidence. HOW MANY PEOPLE ARE SICK Mortality - CORRECT ANSWER death rate. PEOPLE WHO HAVE DIED. Metabolism - CORRECT ANSWER conversion or breakdown of a substance from one form to another by a living organism metabolites - CORRECT ANSWER substance produced by biological processes metabolomics - CORRECT ANSWER use of genomic information to facilitate studies of metabolic processes. Latency - CORRECT ANSWER time from 1st exposure until the appearence of a toxic effect. IRIS (integrated risk information system) - CORRECT ANSWER descriptive, quantitative regulatory information on chemicals. health professionals not experts. Incidence - CORRECT ANSWER # of new cases in a defined population over a specific time period. hydrophilic - CORRECT ANSWER strong affinity for water hydrophobic - CORRECT ANSWER strong aversion for water helminths - CORRECT ANSWER group of parasites that infect humans (Schistosoma haematobium) cestodes: beef and pork tapeworms HACCP (hazard analysis and critical control points) - CORRECT ANSWER production control system for the food industry. identifies potential contamination and then strictly manages and monitors points. designed to *prevent* rather than catch. gray (Gy) - CORRECT ANSWER international system unit of absorbed dose exposure-dose reconstruction - CORRECT ANSWER method of estimating the amount of past exposures to hazardous substances. computers and approximation methods can be used when info is missing or limited. EPCRA (emergency planning and community right-to-know act) - CORRECT ANSWER requirements for federal, stat and local govts regarding emergency planning and CRTK reporting on hazardous and toxic chemicals. -triggered by Bhopal, India 2,000 people died by release of methyl isocyanate. ED50 - CORRECT ANSWER dose of drug that is pharmacologically effective for 50% of the population. disease vector - CORRECT ANSWER intermediate host for parasites. required for development. delivers parasite to subsequent hosts. ex: schistosoma Curie - CORRECT ANSWER basic unit to describe the intensity of radioactivity in a sample of material. cryptosporidium - CORRECT ANSWER microbe that is transmitted through water and person-to-person contact. causes acute diarrhea, stomach pain, vomiting, fever. -milwaukee episode, largest waterborne disease outbreak. Criteria Pollutants - CORRECT ANSWER 1970 ammendment to Clean Air Act. required EPA to set standards for 6 pollutants. ozone, carbon monoxide, total suspended particles, sulfurdioxide, lead, nitrogenoxide. Comparison value - CORRECT ANSWER the calculated concentration of a substance in air, food, or soil that is unlikely to cause harm. used as a screening level during assessment process. Command and Control - CORRECT ANSWER regulates how activities need to be carried out. compliance monitoring and sanctions of trespasses. CONS: inflexibility, not adaptable, no incentive for reaching higher. CBRNE incidents - CORRECT ANSWER deliberate malicious acts with the intention of killing others and disrupting society. CHEMICAL, BIOLOGICAL, RADIOACTIVE, NUCLEAR, EXPLOSIVE. Temporality - CORRECT ANSWER The cause must precede the effect Specificity - CORRECT ANSWER -the proportion of truly nondiseased persons who are so identified by the screening test. -Specificity of the effect is important in assessing possibility of biases true negatives/disease free population D/B+D "of those who do not have disease, __% will test negative." Interaction - CORRECT ANSWER This occurs when the incidence of disease in the presence of two or more risk factors differs from the incidence expected to result from their individual effects Epidemiology's basic ethical principles - CORRECT ANSWER 1. respect for people 2. Beneficence (do not harm) 3. Justice Applications of Epidemiology's basic ethical principles - CORRECT ANSWER 1. informed consent 2. assessment of risk and benefit 3. selection of subjects Tuskegee Syphilis Experiment - CORRECT ANSWER A clinical study conducted between 1932 and 1972 in Tuskegee, Alabama by The U.S. Public Health Service. 399 impoverished African American sharecroppers with syphilis were recruited for research related to the natural progression of the untreated disease. After penicillin was discovered as a cure, researchers continued to deny such treatments to medical participants for another 25 years. Many patients were lied to and given placebo treatments so researchers could observe the progression of the fatal disease. This study led to the 1979 Belmont Report and establishment of the *Office for Human Research Protection (OHRP).* In 1974, Congress passed the National Research Act and created a commission to study and write regulations governing studies involving human participants. Accuracy - CORRECT ANSWER The degree to which a measurement or an estimate based on measurements represents the true value of the attribute that is being measured. Acute Disease - CORRECT ANSWER a health effect with sudden onset, often brief. sometimes used to mean severe. adjusted rate - CORRECT ANSWER a rate in which the effects of differences in composition of the populations being compared have been minimized by statistical measures. Association - CORRECT ANSWER statistical dependence between two or more events, characteristics or other variables. attack rate - CORRECT ANSWER the cumulative incidence of infection in a group observed over a period during an epidemic. Crude rate - CORRECT ANSWER a summary rate based on the actual number of events in a population over a given time period. death rate - CORRECT ANSWER an estimate of the portion of a population that dies during a specific period. #of people dying /population Ecologic study - CORRECT ANSWER a study in which the units of analysis are populations or groups of people rather than individuals. etiology - CORRECT ANSWER the science of causes, causality. Hawthorne Effect - CORRECT ANSWER The effect of knowing that you're being studied influences behavior. healthy worker effect - CORRECT ANSWER workers usually exhibit lower overall death rates than the general population because chronically ill are bared from employment. index case - CORRECT ANSWER the first case in a family or other defined group to come to the attention of the investigator induction period - CORRECT ANSWER the period required for a specific cause to produce disease. the interval from the causal action of a factor to the initiation of the disease. internal validity - CORRECT ANSWER the index and comparison groups are selected and compared in such a manner that the observed differences between them can be attributed only to the hypothesized effect under investigation. lead time bias - CORRECT ANSWER overestimation of survival time, due to the backward shift in the starting point for measuring survival that arises when diseases are detected early (screening procedures). length bias - CORRECT ANSWER a systematic error due to selection of disproportionate numbers of long-duration cases. measurement error - CORRECT ANSWER a mismatch between an estimated value and its true value. natality - CORRECT ANSWER the occurrence of births in a population person-time - CORRECT ANSWER a measurement combining persons and time as the denominator in incidence and mortality rates when, for varying periods, individual subjects are at risk of developing disease or dying. predictive value - CORRECT ANSWER the probability that a person with a positive test is truly positive. or the probability that a person who tests negative is actually negative. probability sample - CORRECT ANSWER all individuals have an equal chance of selection. proportional mortality ratio - CORRECT ANSWER the proportion of observed deaths from a specified condition in a defined population, divided by the proportion of deaths expected from the condition in a standard population. expressed on an age-specific basis or after age adjustment. p-value - CORRECT ANSWER the probability that a test statistic would be as extreme as or more extreme than observed if the null hypothesis were true. small p-value <.05 leads to rejection of the null hypothesis. the result is statistically significant. large p-value >.05 leads to fail to reject the null hypothesis. there was no effect. quasi-experimental study - CORRECT ANSWER investigator lacks full control over allocation or timing, but conducts the study as if it were an experiment. relative risk - CORRECT ANSWER -measure of the association between exposure to a particular factor and risk of a cetain outcome. -doesn't measure probability that someone with the factor will develop the disease incidence rate among exposed/ incidence rate among nonexposed sensitivity - CORRECT ANSWER the proportion of truly diseased persons in the screened population who are identified as diseased by the screening test. "of those who have the disease, __% will test positive" disease not diseased total positive a b a+b negative c d c+d total a+c b+d a+b+c+d a= true positives b= false positives c=false negatives d=true negatives sensitivity = a/(a+c) specificity= d/(b+d) predictive value (positive test result) a/(a+b) predictive value (negative test result) d/(c+d)3 standardized mortality ratio - CORRECT ANSWER the ratio of the number of deaths observed in the study group or population to the number that would be expected if the study population had the same specific rates as the standard population x100. usually a percentage. temporality - CORRECT ANSWER the timing of information about cause and effect. Validity - CORRECT ANSWER measurement: does it measure what it says it does? study: the degree to which the inferences drawn from the study are warranted. vital statistics - CORRECT ANSWER systematically tabulated information on deaths, births, marriages, etc. proportionate mortality ratio - CORRECT ANSWER calculated as the number of deaths within a population due to a specific disease or cause divided by the total number of deaths in the population. Case Control Study - CORRECT ANSWER ODDS RATIO -no incidence data -nested CC: inside of a cohort study -rare diseases, outbreak studies -looks at 1 outcome and infinite exposures -good when little is known about disease -cheap and fast -difficult to infer temporal relationship between exposure and disease Eras of Public Health - CORRECT ANSWER 1. battling epidemics (before 1850) 2. building state and local infrastructure 3. filling gaps in medical care delivery 4. preparing for and responding to community health threats. Biochemical oxygen demand (BOD) - CORRECT ANSWER Measure of the amount of oxygen consumed in the biological processes that break down organic matter in water BOD5 - CORRECT ANSWER amount of oxygen consumed in 5 days by biological processes breaking down organic matter. Biota - CORRECT ANSWER animal and plant life in a given area bench-scale tests - CORRECT ANSWER lab testing of potential clean up technologies Basal Metabolic Rate - CORRECT ANSWER the rate at which heat is given off by an organism at complete rest background level - CORRECT ANSWER 1. the concentration of a substance in the environment that occurs naturally or is not the result of humans. 2. the concentration in a defined area during the fixed time before data was gathered. ALARA - CORRECT ANSWER AS LOW AS IS REASONABLY ACHIEVEABLE best interest vs. economics of improvements and utilization of nuclear energy Apoptosis - CORRECT ANSWER programmed cell death. the body's normal method of disposing of damaged or unwanted cells. Antagonism/Antagonistic Effect - CORRECT ANSWER combined effect of 2+ factors is smaller than the solitary effect of any single factor analyte - CORRECT ANSWER a substance that is undergoing analysis or being measured Additive effect - CORRECT ANSWER biologic response to exposure to multiple substances that equals the sum of responses to all the individual substances added together. Acute exposure - CORRECT ANSWER a single exposure to a toxic substance which may result in severe harm or death. no longer than one day. Environmental Justice & Executive Order 12989 - CORRECT ANSWER -Bill Clinton -fair treatment and meaningful involvement of ALL people in development and enforcement of environmental laws, regulations, and policies. -US EPA, ATSDR and NIEHS?NIH to address the disproportionately high impact on health for minority and low-income communities. Health Impact assessments - CORRECT ANSWER -Used to guide land use decisions and community design with a PH lens. 1. screen for usefulness 2. scoping to identify health effects of concern 3. assessing risks and benefits for target pop 4. make recommendations 5. report findings 6. evaluate how HA affected final decision The 4 components of risk assessments - CORRECT ANSWER Hazard identification, dose-response evaluation, exposure assessment, risk characterization RA: Hazard identification - CORRECT ANSWER identify contaminants that may cause hazards and identify contaminants of concern to be further evaluated. RA: dose-response evaluation - CORRECT ANSWER quantitatively determine the relationship between exposure to toxicant and disease. relies on mathimatical models. RA: exposure assessment - CORRECT ANSWER development of quantitative estimate of magnitude, duration, frequency and timing of an exposure to toxicant RA: risk characterization - CORRECT ANSWER integrates all other steps to estimate risk. carcinogenic Risk Assessment - CORRECT ANSWER probabilistic models non-carcinogenic Risk Assessment - CORRECT ANSWER reference tools CERCLA: comprehensive environmental response, compensation and liability act - CORRECT ANSWER -superfund -provides oversight and funding to address uncontrolled hazardous waste sites -system of identifying, assessing and cleaning sites by the EPA -also seeking recovery funds from responsible parties -most hazardous sites were added to the NPL (national priorities list) -2002 Brownfields Amendments to aid in economic recovery of lesser contaiminated sites Solid and Hazardous Waste Act 1976 - CORRECT ANSWER -also known as the resources conservation and recovery act (RCRA) -cradle to grave law for toxic substances -hazardous materials are tracked -includes solid wastes Safe Drinking Water Act 1974 - CORRECT ANSWER required routine testing of public drinking water Clean Water Act 1977 - CORRECT ANSWER protected environmental quality of water Clean Air Act - CORRECT ANSWER -Began with Air Pollution Control Act 1955 that had no regulations but provided sources and degrees -1963 CAA authorized development of national program -Air Quality Act: enforcement procedures -1970 NAAQS (lead, ozone, nitrogen dioxide, sulfur dioxide, etc) -1977 control measures and definition of attainment areas -1990 control for 189 toxic pollutants National Environmental Policy Act - CORRECT ANSWER foundation for organized environmental policy. set policy on protecting environmental impact. required development of environmental impact statements Occupational Safety and Health Act of 1970 - CORRECT ANSWER created OSHA( occupational safety and health administration). establishes regulatory exposure levels (PELs: permissible exposure limits). has regulatory inspection authority to assure safe and healthy workplaces. National Institute for Occupational Safety and Health (NIOSH) - CORRECT ANSWER health hazard evaluations and epidemiology as well as research in worker safety. Food and Drug Laws - CORRECT ANSWER -Federal Meat Inspection act of 1906 -Pure Food and Drug Act 1906: provides inspection and forbade spread of poisoned foods and created the FDA -Federal Food, Drug & Cosmetic Act of 1938: defined food and additives Silica and Coal Workers pneumoconiosis - CORRECT ANSWER silica: causes inflammatory lung disease, found in miners, quarry, and stoneworkers. modular lesions in lungs. individuals with silica have an increased risk of TB. CWP: black lung, can diable workers Asbestos (employment context) - CORRECT ANSWER shipyard workers were exposed. there was scarring of lung tissue, resulting in bronchogenic carncinoma and mesothelioma. strong synergistic effect with BC and smoking. occupational exposure examples - CORRECT ANSWER -AML (adverse myelogenous luikemia) from exposure to benzene -liver cancer from exposure to vinyl chloride monomer -bladder cancer from exposure to aniline dyes -asbestos, silica and dust with coalminers Sewage treatment - CORRECT ANSWER primary: separation of coarse objects secondary: digestion by microorganisms 3. physical removal for setting 4. disinfected and discharged to receiving water 5. sludge goes to landfills. water treatment - CORRECT ANSWER flocculation, sedimentation, filtration, and disenfection byproducts of chlorine disinfection are chemicals called trihalomethanes (THMs) and halo-acetic acids (HAAs) ultraviolet radiation - CORRECT ANSWER toxic when exposed to skin and eyes, MELANOMA Electric and Magnetic fields - CORRECT ANSWER power lines, electrical appliances Volitile Organic Compounds (VOCs) - CORRECT ANSWER vaporized at ambient temperatures, found in adhesives. exposure often at the workplace. Radon - CORRECT ANSWER lung cancer, gas, granite rock Nitrates and Nitrites - CORRECT ANSWER found in nitrogen based fertilizers. when in water, it depletes the oxygen=eutrophication asenic - CORRECT ANSWER organic and inorganic forms, used in pesticides and fungicides. known carcinogen. Mercury - CORRECT ANSWER mining. smelting/industrial operations Japan, fish, pregnant women lead - CORRECT ANSWER toxic to organs (renal and neurologic) can cause death children are extra sensitive NOAEL (no observed adverse effect level) -> LD50 (lethal dose that kills 50%) - CORRECT ANSWER endpoints derived from dose-response curves used to evaluate adverse health effects in humans after exposure to a toxicant occurs, 4 KEY TOXICOKINETIC PROCESSES take place: - CORRECT ANSWER -absorption: ingestion, inhilation, dermal contact -distribution: via the bloodstream -metabolism: biotransformation process -excretion: kidney via urine, liver via feces, or breath or breastmilk 5 elements of environmental exposure pathways - CORRECT ANSWER 1. contaminated source 2. contaminated environmental media 3. exposure points 4. exposure routes 5. receptor populations NAAQS (national ambient air quality standards) - CORRECT ANSWER carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone, particulates sulfur dioxide - CORRECT ANSWER increased risk of asthma, breathing issues nitrogen dioxide - CORRECT ANSWER airway inflammation health impact of pesticides - CORRECT ANSWER affects nervous system and degrades environment endocrine disrupting compounds (EDC) - CORRECT ANSWER chemical agents interfering with natural hormones Case-Control Study - CORRECT ANSWER ODDS RATIO (Syn: case-comparison study, case compeer study, case history study, case-referent study, retrospective study) The observational epidemiologic study of persons with the disease (or other outcome variables) of interest and a suitable control (comparison, reference) group of persons without the disease. Case-control studies compare the odds of past exposures to an agent/factor between cases (diseased) and controls (non-diseased). The standard effect estimate /estimate of relative risk in a case control study is the odds ratio (OR) Analytic epidemiology - CORRECT ANSWER the systematic evaluation of suspected relationships, for example between an exposure and a health outcome. These studies have a narrower focus and typically provide stronger evidence concerning particular relationships. These studies usually involve the testing of hypotheses. Types of analytic studies (Observational and Experimental) - CORRECT ANSWER - Case-control studies; comparison of people who develop a condition with people who do not - Follow up studies (retrospective, prospective): a comparison of people with and without a characteristic in relation to a health related event - Intervention trials (clinical, community); comparison of a subsequent experience exhibited by people to whom a treatment or preventative intervention has been given, to that of people not provided that intervention What is the most quantifiable error? - CORRECT ANSWER The most quantifiable error is sampling error, which is the distortion that can occur from the 'luck of the draw' Measures of disease occurrence in incidence studies: Incidence rate (hazard rate/force of mortality/incidence density): - CORRECT ANSWER This is a measure of disease occurrence per unit population time, and has the reciprocal of time as its dimension . Rate ratio(incidence density ratio) is the ratio of the incidence rate in the exposed group to that in the non-exposed group Measures of disease occurrence in incidence studies: Incidence proportion (cumulative risk/average risk): - CORRECT ANSWER This is the proportion of people who experience the outcome of interest at any time during the follow up period. Risk ratio (incidence proportion ratio or cumulative incidence ratio) is the ratio of the incidence proportion in the exposed group to that in the non-exposed group Measures of disease occurrence in incidence studies: Incidence odds: - CORRECT ANSWER This is the ratio of people who experience the outcome to the ratio of people who do not experience the outcome. Odds ratio is the ratio of incidence odds in the exposed group to that in the non-exposed group. prevalence studies - CORRECT ANSWER Prevalence : This denotes the number of cases of disease under study existing in the source population at a particular time. These studies are important as the enable assessment of the level of morbidity and the population disease burden for a non fatal condition. Three types of OBSERVATIONAL STUDIES: - CORRECT ANSWER 1. Cohort Studies 2. Case Control Studies 3. Cross Sectional Studies/Prevalence Studies Marine Hospital System - CORRECT ANSWER -Created in 1798 -Later became the US Public Health Services -Insurance system for merchant seamen that funded coastal marine hospitals -Seamen were at high risk for disease and injury -Goal was to help curb importation of disease John Maynard Woodworth - CORRECT ANSWER -head of Marine Hospital system -turned hospitals into an administration -Established PHS Commissioned Corps Hygienic Laboratory 1887 - CORRECT ANSWER created to research microbes causing infectious diseases. evolved into the NIH. Limited health care services in 1800's and early 1900's - CORRECT ANSWER 1. doctors had little formal training 2. No professional standards 3. care was based on primitive practices 4. No institutional setting 5. Families provided most medical care 6. medical education was substandard Flexnor Report 1910 - CORRECT ANSWER -Evaluated quality of medical education in US and Canada and made recommendations. -commissioned by the Carnegie Foundation. Triggers for hospital transformations in early 1900s - CORRECT ANSWER -understanding of causes of disease -adoption of hygiene and sterilization techniques -expanded diagnostic capabilites -emergence of nurses Hill-Burton Act of 1946 - CORRECT ANSWER provided federal matching funds for community hospitals -these hospitals had to offer care regardless of a patient's ability to pay. Employer sponsored insurance (ESI) - CORRECT ANSWER -established in WW11 in response to wage and price controls and a tight labor market Medicare (1965) - CORRECT ANSWER -funded through payroll taxes, general revenue and premiums. -45 million people & 14% of fed budget -Part A: hospital insurance -Part B: supplemental medical insurance (drs) -Part C: medicare advantage (alt's) -Part D: prescription drug coverage Medicaid (1965) - CORRECT ANSWER -Administered by state govt and matched by the fed govt (50-76%). health care services are delivered by: - CORRECT ANSWER -local and state pH agencies, but large part of funding is federal. - US constitution doesn't mention health, so it's the states responsibility Common PH State functions - CORRECT ANSWER -collecting and analyzing health statistics -providing PH education to the public -maintaining state laboratories -establishing and policing PH standards -granting licenses to health professionals -monitoring performances of institutions -policies for local govt PH agencies -giving financial support to agencies LPHA - CORRECT ANSWER local, public health agencies -admin and service unit of local govt -responsible to the state govt for effective execution of PH functions -3,200 local boards of health determinants of health - CORRECT ANSWER social, behavioral, environmental, and biological/physical Policy Analysis - CORRECT ANSWER systematic investigation of policy alternatives based on the assembly of evidence for or against each alternative. -both problem analysis and solution analysis -quantitative & qualitative solution analysis - CORRECT ANSWER should consider the technical, economic, and political feasibility of alternative policies, implementation strategies, and the predicted outcomes of policy adoption. Policy Development Process - CORRECT ANSWER 6 stages: 1. setting the agenda 2. policy formation 3. policy adoption 4. implementation 5. administration 6. consequences 7. evaluation Prion - CORRECT ANSWER misshapen proteins that cause brain degeneration in conditions such as mad cow disease and Cruetzfeldt-Jakob disease. climate change impact on disease - CORRECT ANSWER increase in dengue Strategic Planning - CORRECT ANSWER process of determining where the organization wants to be in the future and how it's going to get there. must be a proactive and ongoing process. foundation: org's vision, mission and values involves: environmental scan, strategy formulation, implementation and evaluation. environmental scan or SWOT - CORRECT ANSWER SWOT (strengths, weaknesses, opportunities, and threats) -is an assessment of the org's internal strengths and weaknesses and the external opportunities and threats. PEST - CORRECT ANSWER (political, economic, social and technical) analysis of the environment that can affect an org's future performance. tactical plan - CORRECT ANSWER breaks down strategic plan into specific, short-term actions and plans and assigns responsibility for specific areas. -needs flexibility to address unplanned events implementation plan - CORRECT ANSWER outlines the process for communicating the strategic plan to employees and getting buy-in. -can be modified in response to employee feedback Marketing - CORRECT ANSWER creating, communicating and delivering health information, services, and interventions 4 P's of PH marketing - CORRECT ANSWER product, price, place, promotion steps of effective communication - CORRECT ANSWER 1. planning and strategy development 2. developing and pretesting concepts, messages and materials 3. implementing the program 4. Assessing effectiveness and making refinements 10 essential functions performed by PH professionals - CORRECT ANSWER monitoring, diagnosing and investigating, informing and educating, mobilizing, developing policies and plans, enforcement, creating linkages, assurance, evaluation, and research HR functions - CORRECT ANSWER staffing mgmt, training and development, compensation and benefits, employee relations, labor relations. Transactional Leadership - CORRECT ANSWER assumes that employees only perform their work because they are rewarded. designs tasks and reward structures that create incentives to increase productivity or higher standards of quality. employees have little input. DOES NOT generate strong work relationships or create a long-term motivating environment. uses rewards and punishments to gain compliance. Autocratic leadership - CORRECT ANSWER extreme form of transactional leadership. exerts absolute power over employees. creates resentment, high absenteeism and turnover. can be effective for rountine and unskilled jobs bureaucratic leadership - CORRECT ANSWER insists that employees follow rules and procedures precisely. appropriate for work that is dangerous or has a high risk of failure. charismatic leadership - CORRECT ANSWER generates enthusiasm and inspires employees to higher levels of achievement. does not encourage commitment to a shared vision. leadership void if leader leaves org. democratic or participative leadership - CORRECT ANSWER employees are involved in decisions. final decision is left to leader. engenders job satisfaction and employees develop their skills. employees have control over their work, increased satisfaction. process takes more time, but good when quality is more important than efficiency. Laissez-faire leadership - CORRECT ANSWER most appropriate when employees are very skilled and expereinced. relationship-oriented leadership - CORRECT ANSWER focused on organizing, supporting and developing employees. encourages teamwork and creative collaboration. usually used in combination with other approach. servant leadership - CORRECT ANSWER informal leader who leads by meeting the needs of the team. often involves others in decision making. effective where values are important and leader has power on basis of values and ideals. transformational leadership - CORRECT ANSWER inspires employees to share in their vision for the organization. their enthusiasm motivates employees. may need to rely on others to attend to details. Alderfer's ERG theory - CORRECT ANSWER Existence, relatedness, growth (ERG) -drew on maslow's hierarchical theory -argued that an individual's motivations could move forward and backward through levels of motivation. -cut MHT to 3: existence, relatedness, growth Herzberg's Two Factor Theory - CORRECT ANSWER job satisfaction: INSTRINSIC challenging, responsibility, opportunties for growth job DISsatisfaction: EXTRINSIC salary, job security, company policy. fixing job dissatisfaction will not improve job satisfaction. McClelland's Acquired Needs Theory - CORRECT ANSWER needs are learned and developed as a result of one's life experience 3 types of needs: 1. need for achievement 2. need for affiliation 3. need for power Skinner's Reinforcement theory - CORRECT ANSWER 4 types of reinforcement influence an individual's motivation. 1. desirable behavior=positive reinforcement, negative reinforcement or avoidance learning 2. undesirable behavior= punishment, extinction Adam's Equity Theory - CORRECT ANSWER motivation is determined by how equitably an employee perceives they are treated compared to others in the org. Expectancy Theory - CORRECT ANSWER employee motivation is a function of the employees' belief that 1. putting more effort into the job will result in better performance 2. better job performance will be rewarded 3. predicted rewards are valuable. Locke's Goal setting theory - CORRECT ANSWER individuals are motivated to improve their performance when given challenging and specific goals. they must be interested in attaining the goal and adopting it as their own. McGregor's XY theory - CORRECT ANSWER theory x: employees naturally dislike work and avoid responsibility, they must be compelled to work. theory Y: they are naturally motivated. managers help them achieve their full potential by giving them work to do. Attribution Theory - CORRECT ANSWER perceptions influence whether we attribute the behavior to the individual's personality or to the circumstances in which it occurred. unmotivated or there just isn't enough work? Control function - CORRECT ANSWER systematic process of measuring performance and taking corrective action to ensure that organizational are being met. balance sheet - CORRECT ANSWER details that financial assets, liabilities, and equity @ a specific point in time. retrospective reimbursements for HC providers - CORRECT ANSWER price is determined after service is delivered. fee-for-service. prospective reimbursements for HC providers - CORRECT ANSWER $ is determined before service and is based on a contractual arrangement between provider and payer. -MEDICARE uses this bundled payments for HC providers - CORRECT ANSWER fixed amount is paid to treat a patient and is to be shared by all providers capitation - CORRECT ANSWER health plans pay providers ad fixed amount per enrollee per month in exchange for contractually specified set of services in the future. quality gap in PH - CORRECT ANSWER occurs when there is a difference between health care processes or outcomes observed in practice and those thought to be achievable given current and effective professional knowledge. Assessment of quality - CORRECT ANSWER structure, process, and outcome quality improvement - CORRECT ANSWER CQI (continuous quality improvement) begins by investigating the potential causes, indentifying remedial measures that address the source of the error, implmenting the process improvement and then evaluating the results. total quality mgmt - CORRECT ANSWER mgmt philosophy that focuses on: 1. customer focus 2. continuous improvement 3. teamwork National Incident Mgmt System (NIMS) - CORRECT ANSWER -2003 to assure greater consistency of emergency mgmt systems. the DHS are responsible for developing and implementing NIMS. federal grants are awarded based on states compliance to NIMS compatibility. Incident Command Systems (ICS) - CORRECT ANSWER used to facilitate decision making during emergencies. involves procedures and structures developed in advance to coordinate effective responses in emergencies. -key comonents: common terminology, modular organization, integrated communications, unified command structure, consolidated action plans, manageable span of control, designated incident facilities and comprehensive resources mgmt. Issues in PH - CORRECT ANSWER -large and increasing # of uninsured americans -limited financing for PH activities -overemphasis on speciality care vs. primary care -escalating health care costs ethical and legal basis for PH - CORRECT ANSWER -state's authority to enforce PH laws arises from its policy powers -ultimate legal authority to PH laws is based in the US constitution Policy process for improving health status for pops - CORRECT ANSWER agenda setting, policy formulation, policy adoption, implementation, administration, consequences, and evaluation. systems theory - CORRECT ANSWER addresses the numerous interrelated problems that affect a community's health. encourages long-term solutions that include community-building as well as specific interventions. community rating of health insurance - CORRECT ANSWER spreads the risk of insuring the small percent of frequent and costly users across the total # of insured backward vertical integration - CORRECT ANSWER the creation or acquisition of early stages in the process of health care service delivery. accounts receivable mgmt - CORRECT ANSWER mgmt of the $ that is owed to a venture for goods and services that have been purchased or committed. (current assets) advance directive - CORRECT ANSWER written or spoken statement about a person's future medical care. ex: living will and power of attorney adverse selection - CORRECT ANSWER describes the tendency for only those who will benefit from insurance to buy it. principal-agent problem - CORRECT ANSWER principal-agent problem treats the difficulties that arise under conditions of incomplete and asymmetric information when a principal hires an agent. -agency relationship, in which one party delegates work to the other. ambulatory care - CORRECT ANSWER outpatient/medical care that doesn't involve an overnight hospital stay Sherman Antitrust Act - CORRECT ANSWER -1st US govt statute to limit cartels and monopolies. -felony charge -put responsibility upon govt attorneys and district courts to pursue and investigate Individual level theories of change - CORRECT ANSWER health belief model theory of planned behavior transtheoretical model -used to understand and change individual health behaviors. focused on factors within the individual. interpersonal level theories of change - CORRECT ANSWER social cognitive theory social support/social network theory stress and coping social influence organization and community level theories of change - CORRECT ANSWER organizational change theory community organization theory comunication theory diffusion of innovation Health Belief Model - CORRECT ANSWER -first used in a TB screening program -An individual's beliefs are determinants of behavior -perceptions of the threat of health problem, appraisal of the recommended behavior to prevent problem and cues to action impact behavior -perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy -self-efficacy was added in 1980s theory of reasoned action - CORRECT ANSWER -behavioral intentions are predictors of behavior -individual attitudes impact behavior -people are rational TPB expands this theory reciprical determinism - CORRECT ANSWER behavior, interpersonal factors, and environmental events interact as determinants of each other. change in 1 results in a change in the other 2 social support/social network theory - CORRECT ANSWER relationships between people influence beliefs and behaviors -emotional support, tangible support, informational support, appraisal support social network components: 1. centrality vs. marginality (degree of interaction) 2. reciprocity of relationships 3. complexity of relationships 4. homogeneity/diversity 5. subgroups 6. communication patterns stress and coping theory - CORRECT ANSWER -coping strategies as determinants of health stressors: 1. ambient environment (continuous envi factors) 2. major life events (disrupts normal activities) 3. daily hassles 4. chronic strains (poverty, discrimination) 5. cataclysmic events (disasters, war) constructs: 1. primary appraisal 2. secondary apppraisal 3. coping efforts 4. problem mgmt 5. emotional regulation social influence theory - CORRECT ANSWER social influence is a process directed at behavior change -health care provider suggests change organizational change theory - CORRECT ANSWER -org policies and practices are determinants of health 1. stage approach: ordered steps as changing. strategies need to be matched to the org's level 2. development approach: improves climate, culture, and capacity in work environment. continuous improvement 4 stages: 1. assessing and improving group dynamics 2. encouraging shared goals 3. identifying org barriers to change 4. identifying and implementing new policies and practices community organization theory - CORRECT ANSWER -community organization and community building as determinants of health -community members help identify health problems that exist, mobilize resources and design and implement strategies to reach common goals concepts: 1. locality development (consensus/cooperation) 2. social planning (uses outside expert for problem solving) 3. community capactity (identify, mobilize and address community problems) 4. issue selection (winable changes) 5. participation (community engagement) 6. relevance (community defined needs) arbitration - CORRECT ANSWER legal technique for resolution of disputes outside the courts. people refer the decision making to an agreed upon party and are bound to the decision. -mediation assisted living facilities - CORRECT ANSWER -govt doesn't require established standards like it does for nursing homes (who participate in medicare) ALOS (average length of stay) - CORRECT ANSWER statistical calculation used for health planning purposes. bad debt expense - CORRECT ANSWER portion of receivables that can no longer be collected. typically from accounts receivable or loans. considered an expense. how to account for it: 1. direct write off method: receivable which is not considered collectable is charged directly to the income statement. 2. allowance method: estimate made at the end of each fiscal year of the amount of bad debt. it's then accumulated in a provision. Baldrige National Quality Award - CORRECT ANSWER -created by public law in 1987 -led to the creation of a new public-private partnership -Malcolm Baldrige: secretary of commerce 1. national increase in quality reduces costs, high competition, reduced costs, 2. applicable to small and large businesses 3. manager-led, customer-oriented 4. national award program bargaining unit - CORRECT ANSWER group of employees with a clear community of interests who are represented by a single labor union in collective bargaining and other dealings with mgmt. barriers to entry - CORRECT ANSWER obstacles in the path of a firm that wants to enter a given market. also can be applied to individual or trade. Belmont Report - CORRECT ANSWER -1976 @ Smithsonian institute -summarizes the basic ethical principles identified by the commission for protection of human subjects... -published in the Federal Register National Research Act (1974) - CORRECT ANSWER created the national commission for the protection of human subjects and biomedical and behavioral research. -they were charged with identifying basic ethical principles that should underlie the conduct of research. and develop guidelines that should be followed. 1. boundaries btwn research & medicine 2. role of risk-benefit assessment 3. selection of human subjects 4. informed consent benchmarking - CORRECT ANSWER process used in mgmt to evaluate aspects of their processes in relation to best practice within their sector. -helps to develop plans with the aim of increasing performance. -continuous process biomedical ethics - CORRECT ANSWER core values: beneficence, non-malfeasance, autonomy, justice, dignity, truthfulness and honesty bonds (payable) - CORRECT ANSWER a formal written promise to pay interest every six months and the principal amount at maturity capital budgeting - CORRECT ANSWER planning process used to determine whether firm's long-term investments such as new machinery are worth pursuing. capital expenditures - CORRECT ANSWER expenditures creating future benefits. capitation (rate) - CORRECT ANSWER method of payment to a provider of medical services according to the number of members in a health benefit plan that the provider contracts to treat. (it also means cost per person) case mix index - CORRECT ANSWER the average diagnosis-related group weight for all of a hospital's medicare volume. can be used to adjust the average cost per pt for a given hospital relative to the adjusted average cost for other hospitals. charge master - CORRECT ANSWER comprehensive and hospital-specific listing of each item that could be billed to a pt, payers or other care provider community hospital - CORRECT ANSWER includes all non-federal short-term general and special hospitals whose facilities and services are available to the public. community rating (health insurance) - CORRECT ANSWER an insurer using community rating to set insurance premiums ignores any differences in expected costs among insured groups or people. If an insurer uses community rating, but people know and use their expected costs to decide whether or not to buy insurance, then only the sickest people may end up signing up for insurance. co-optation - CORRECT ANSWER an election where members of a committee vote in order to fill a vacancy on that committee. not always suitable because it doesn't represent the groups represented by the past member. cost containment - CORRECT ANSWER occurs when an insurance company attempts to reduce the benefit payment or costs associated with the health plan. cost sharing - CORRECT ANSWER costs shared between an employee and their employer cost shifting - CORRECT ANSWER above-cost revenue collected from other patient populations. cost-to-charge ratio - CORRECT ANSWER a rate setting methodology using a ratio of costs of services and procedures to charges of those services or procedures in the hospital setting. covered lives - CORRECT ANSWER # of individuals and dependents enrolled in a health insurance plan. if not available, a formula can be used to derive the #. debenture - CORRECT ANSWER a certificate acceptance of loans which is given under the company's stamp and carries an undertaking that the debenture holder will get a fixed return and the principal amount when it matures. demand mgmt - CORRECT ANSWER the art or science of controlling economic demand to avoid a recession. also the mgmt of distribution of goods and services based on needs. diagnostic-related group (DRG) - CORRECT ANSWER a system to classify hospital cases into one of 500 groups, expected to have similar hospital resource use. developed for Medicare as part of the prospective payment system. -they've been used since 1983 to determine how much Medicare pays the hospital. disproportionate share hospital (DSH) - CORRECT ANSWER US govt provides special funding to hospitals who treat significant pops of indigent pts through the DSH program. employee assistance program (EAP) - CORRECT ANSWER employee benefit programs offered by employers in conjunction with a health insurance plan. they are intented to help employees with personal problems that might adversely impact their work performance/health/wellbeing. generally includes short-term counseling, assessment, referral services. Equal employment opportunity commission (EEOC) - CORRECT ANSWER US govt agency dedicated to upholding title VII of the civil rights act of 1964, which prohibits discrimination in employment on the basis of race, color, national origin and gender. Equity Theory of pay (adams) - CORRECT ANSWER attempts to explain relational satisfaction in terms of perceptions of fiar/unfair distributions of resources within interpersonal relationships. first developed in 1963 who asserted that employees seek to maintain quity between inputs that they bring to a job and outputs that they receive against inputs and outputs of others. experience rating - CORRECT ANSWER statistical procedure used to calculate a premium rate based on the loss experience of an insured group. applied in group insurance, it is the opposite of manual rates. the premiums paid are related to actual claims and expense experience expected for that specific group. 5 P's of strategy - CORRECT ANSWER plan, ploy, pattern, position and perspective global rate (reimbursement) - CORRECT ANSWER a risk-adjusted rate given by insurance providers based on several factors such as age, sex, complications and comorbidities. health maintenance organization (HMO) - CORRECT ANSWER health care system that assumes or shares both the financial risks and the delivery risks associated with providing comprehensive medical services to a voluntarily enrolled population in a particular area in return for a fixed, pre-paid fee. Health Plan Employer Data and Information Set (HEDIS) - CORRECT ANSWER 71 measures across 8 domains of care developed by national committee for quality assurance. used to make improvements in quality of care and service. used to select best health plan. they are rigorously audited by certified auditors. horizontal integration - CORRECT ANSWER type of ownership and control. strategy used that seeks to sell a type of product in numerous markets. indemnity insurance - CORRECT ANSWER fee-for-service insurance with a high degree of choice for insured. leverage (debt financing) - CORRECT ANSWER using given resources in such a way that the potential positive or negative outcome is magnified. linking pin theory of mgmt (likert) - CORRECT ANSWER idea that organizations are represented as a number of overlapping work units in which members of one unit are leaders of another. managed care organization (MCO) - CORRECT ANSWER HMO:only pay for care when the network you choose a primary care dr. PPO: pay more if you get care in network POS: let you choose each time between PPO and HMO medigap insurance - CORRECT ANSWER health insurance sold by private insurance companies to fill the gaps in medicare. moral hazard - CORRECT ANSWER a party insulated from risk may behave differently than if it were fully exposed to risk. MH arise because an institution doesn't bear the full consequences of its actions, therefore it has a tendency to act less carefully leaving another party to bear responsibility. net assets (equity) - CORRECT ANSWER value of one's assets less the value of liabilities oligopolistic markets - CORRECT ANSWER market that is dominated by a small number of sellers open system - CORRECT ANSWER system that is capable of self-maintenance on the basis of throughput of resources from the environment. it continuously interacts with its environment. mechanistic model of an organization - CORRECT ANSWER extremely stable with a high degree of specialization and imposition of rules, high level of authority organic model of an organization - CORRECT ANSWER low degree of specialization, broad knowledge of many different jobs. little top-level authority. high degree of self-control and coordination between peers. path-goal theory of leadership - CORRECT ANSWER a leader's function is to clear the path toward the goal of the group by meeting the needs of the subordinates. physician-hospital organization (PHO) - CORRECT ANSWER includes hospitals and physicians contracting with one or more HMO, insurance plans, or directly with employers to provide health care services. point-of-service plan - CORRECT ANSWER plan that allows beneficiaries to choose a provider that is or is not within a healthcare plan. provides more choices, but can be more expensive. separated segregated funds PACS - CORRECT ANSWER political committees that can only solicit funds from individuals associated with the organization. non-connected committees PACS - CORRECT ANSWER political committees that aren't sponsored or connected and are free to solicit contributions from the general public. prospective payment system (PPS) - CORRECT ANSWER method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. prices are determined by classification system. portability - CORRECT ANSWER employee's right to keep or maintain certain benefits when switching employers or when retiring. quality-adjusted life year (QALY) - CORRECT ANSWER unit of health care outcomes that adjusts gains or losses in years of life subsequent to a health care intervention by the quality of life during those years. resource-based relative value scale (RBRVS) - CORRECT ANSWER a scale of national uniform relative values for all physicians' services. revenue cycle - CORRECT ANSWER the time between the organization's delivery of services and its receipt of payments for those services. safe harbor requirement - CORRECT ANSWER approved by the EU in 2000 -developed to create bridge between EU and US privacy protection policies -certifying "SH" shows to EU companies that you are proving "adequate" privacy protection. sentinel event - CORRECT ANSWER any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a person, not related to the natural course of the pt's illness. small area variation - CORRECT ANSWER research analysis tool used by health services researchers to describe how rates of health care use and events vary over well-defined geographic areas. sub-acute care - CORRECT ANSWER level of care needed by a patient who doesn't require hospital acute care, but more care than is available in a nursing home. technical quality (of health care) - CORRECT ANSWER how well a health plan or hospital prevents and treats illnesses. total quality mgmt (TQM) - CORRECT ANSWER mgmt strategy aimed at embedding awareness of quality in all organizational processes. up-coding - CORRECT ANSWER when false diagnosis codes were assigned to pt's records in order to increase reimbursement to the hospital by medicare, medicaid, etc. utilization review - CORRECT ANSWER reviews claims, services or procedures in organization to ensure the service was necessary and appropriate. vertical integration - CORRECT ANSWER organizations united by hierarchy and share a common owner. american with disabilities act (ADA) - CORRECT ANSWER 1990. clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities. balanced budget act of 1997 - CORRECT ANSWER -Clinton -created CHIP -new medicaid care options and requirements for states Civilian health and Medical Program for the Uninformed Services (CHAMPUS) - CORRECT ANSWER 1996 requirements and procedures for the implementation of the TRICARE program (comprehensive managed health care delivery system of military medical treatment facilities). coordinated military and civilian systems Consolidated Omnibus Budget Reconciliation Act (COBRA) - CORRECT ANSWER 1986 gives workers who lose their health benefits the right to choose to continue group health benefits provided by the plan under certain circumstances. Emergency Medical treatment and Active Labor Act (EMTALA) - CORRECT ANSWER 1986 ensures access to emergency services regardless of ability to pay. if a hospital is unable to stabilize a pt within its capability, an appropriate transfer should be implemented. Health Care Ammendments to the National Labor Relations Act of 1974 (NLRA) - CORRECT ANSWER in 1935 an act protected the rights of employees and employers, encouraged collective bargaining. in 1974 this was amended to include hospitals, clinics, nursing homes, etc. Health Maintenance Organization Act of 1973 (HMO) - CORRECT ANSWER provided grants and loans to start a HMO, required companies to offer HMO options. gave individuals more options. Medicare Modernization Act (MMA) - CORRECT ANSWER 2003 -most changes since establishment -drug discount card -covers preventative benefits -flexibility in coverage Ryan White CARE act - CORRECT ANSWER 1990 supports the development of systems of care that are responsive to local needs and resources. founded on strong partnerships between federal, state and local communities. emphasizes primary care over ER visits. social security act of 1935 - CORRECT ANSWER did not provide intended comprehensive package of protection. did provide a range of programs: unemployment insurance, old-age assistance, aid to dependent children. asset mapping - CORRECT ANSWER component of c