D1 DSCI Review PDF

D1 DSCI REVIEW Consolidated and Presented by Emma Giannini Material from Dr. Elwazeer & Dr. Rosenthal July 30th, 2024 Emma Giannini [email protected] (978) 602-0751  TOPICS OVERVIEW Health Literacy TeamSTEPPS Health Be...

D1 DSCI REVIEW Consolidated and Presented by Emma Giannini Material from Dr. Elwazeer & Dr. Rosenthal July 30th, 2024 Emma Giannini [email protected] (978) 602-0751  TOPICS OVERVIEW Health Literacy TeamSTEPPS Health Behavior Theories Intro to Epidemiology Social Support and Adherence Study Designs Transfer and Referrals Qualitative vs quantitative Social Justice Case control Alternative Medicine Cohort RCT ACA & Healthcare System Meta-analysis VBC and Payment Biases and Confounders  INTRO TO EPIDEMIOLOGY Types of prevention Endemic: background rate of disease Primordial: prevents risk factors of Epidemic: excess of an illness in a disease region Primary: prevents disease Pandemic: excess of an illness Secondary: identifies asymptomatic worldwide patients with disease Heard immunity: threshold of immunity Tertiary: prevents complications from needed for disease to die out those symptomatic with disease Varies by disease, ie measles = 94% Quaternary: measures taken to decrease harm done by health activities  INTRO TO EPIDEMIOLOGY Incidence: = # NEW cases / # at risk Prevalence = # of cases / # in population Mortality = # of deaths in year / # in population at midyear Case fatality = # of deaths from disease / # of people with disease STUDY DESIGNS  C ASE CONTROL Observational & analytical Matching: pairing cases & controls to address confounders Begin with two groups: CASE and CONTROL Individual matching: each case is matched with Then separate each based on exposure control(s), may be 1:1, 2:1, 3:1, etc Useful for rare diseases, long latency Frequency matching: cases and controls have the same distribution (ie 70% Hispanic, 30% smokers, Can’t determine incidence, prevalence, or etc) temporal relationship Case crossover study Biases Controls are matched to themselves Neyman’s (selection): patients who died or are asymptomatic tend to me excluded Must be acute outcome Use incidence cases (first diagnosed) Short lag between exposure and disease Recall: patients may not remember exposure Exposure is intermittent and variable, cannot be trending over time  Observational & analytical Begin with two groups: EXPOSED and NOT EXPOSED Then separate each based on outcome Two types: prospective and retrospective Useful for rare exposures, can measure temporal relationship and incidence COHORT Expensive, time-consuming, loss of patients can invalidate STUDIES  ABSOLU TE RISK ❖ Absolute risk: Probability a disease-free individual will develop disease over period of time ❖ Incidence rate = (# of new cases / # of person-years) x 100,000 ❖ Cumulative incidence = (# of new cases which were exposed / total # of exposures) x 100  RELATIVE RISK Relative risk: Ratio of risk for disease in exposed vs unexposed groups over period of time Rate ratio: incidence rate exposed / incidence rate not exposed Risk ratio: cumulative incidence exposed / cumulative incidence not exposed  ATTRIBUTABLE RISK Attributable risk: how many disease cases can we attribute to exposure? (among exposed) Population attributable risk: how many disease cases can we attribute to exposure? (in total population)  RANDOMIZED CONTROLLED TRIALS (RCT) Experimental & analytical Most powerful evidence possible from single study Expensive, time-consuming, strict regulations Two groups: INTERVENTION and CONTROL Randomization: intervention vs control group sorting must be random Blinding: don’t reveal which group pt is in to pt (single) or provider (double) Phases 0-4 Ethical complications  RAN D OM IZED C ON TROL L ED TRIA LS (RC T) Number Needed to Treat (NNT): number of patients who must receive tx for 1 to benefit Number Needed to Harm (NNH): number of patients who must receive tx for 1 to be harmed  SYSTEMATIC REVIEWS & META - ANALYSIS Systematic review: summary of evidence from multiple studies Meta-analysis: mathematical combination of results Need clear inclusion/exclusion criteria Develop clear question P: population I: intervention / exposure C: control group O: outcomes Heterogenicity quantified by inconsistency index Must be low to perform meta-analysis Fixed effects: assumes there is a fixed value in the whole population which all studies are aiming for Random effects: assumes each study population has its own value, which falls on a distribution among whole population Garbage in → garbage out  BIASES Bias: systematic error resulting in wrong Information bias: information about estimate of exposure/outcome participants is wrong Selection bias: study participants differ from Recall bias: patients often don’t remember population being studied correctly Self-selection bias: those who opt-in differ Response bias: patients lie to avoid from those who opt-out judgement or shame, especially common in surrogate interviews Healthy worker effect: workers generally healthier than unemployed Observer bias: researchers’ expectations influence what they think they see To mitigate: only compare workers to other workers Misclassification: patients are put in wrong group Berksonian bias: hospital cases generally differ from control cases Non-differential or differential  CONFOUNDERS VS EFFECT MODIFIERS Confounder: variable associated with Effect modifier: variable affecting the strength of exposure which can cause disease association between exposure and disease Collider: variable caused by 2+ other variables and affecting outcome  HEALTH LITERACY Definition: Ability to obtain, process and understand Strategies: basic health information needed to make appropriate health decisions Use plain language (gums, not gingiva) Only 12% of US adults have proficient health literacy Review medication instructions Often labeled ”non-compliant” Use percentages, NOT proportions Typically worse in: Many people think 1 in 4 is larger than 1 in 3 Older adults More people understand 33% is larger than 25% Low income Ask open-ended questions (not yes/no) Low education Minorities Teach back method ESL patients  HEALTH BEHAVIOR THEORIES Classical conditioning Neutral stimulus linked with positive or negative stimulus, causing neutral stimulus to produce response Tx: flooding, systematic desensitization Operant Conditioning Positive = adding stimulus Negative = removing stimulus Reinforcement = good behavior Punishment = bad behavior  HEA L TH B E HA VI OR T HEO RIES TRANS-THEORETIC AL MODEL (TTM)  THEO RY OF PL A NN ED B EHAVIO R (TPB ) Behavioral beliefs – Is the behavior good for me? Normative beliefs – Are my friends and family doing the behavior? Control beliefs – Can I control the behavior?  SOC IAL S UPPORT AND ADHERENCE Social support networks are crucial to healing Group sessions Compliance Adherence Typically: Simple Quick Immediate benefit Solutions: Blame-free environment Adjust dosing Improve education/health literacy  TRANSFERS AND REFERRALS Referrals must be for patient need ONLY Code of Ethics – veracity – no financial benefit Explain reason for referral, use teach-back Pt should be involved in choosing specialist Two types: clinical and social services Components What exactly you are asking for Supporting data (x-rays, photos, etc) Relevant pt info (language, transportation, etc) Close the referral loop (how to contact you after pt is seen) Utilize community health workers / promotor(a) SOCIAL JUSTICE  SOCIAL JUSTICE Barriers to care Structural Financial Personal/cultural Equity, not equality Institutionalized racism: differential access to goods, services, and opportunity of society based on race Housing, healthcare access, etc Personally-mediated racism: differential assumptions about others’ abilities and intents based on race Physician disrespect, police brutality, etc Internalized racism: acceptance by stigmatized races of negative messages about own abilities and worth ACA & HEALTHCARE SYSTEM MEDIC ARE AFFORDABLE C ARE AC T (AC A)  TEAM STEPPS Leadership Situation monitoring Situation vs designated leaders Cross monitoring: monitoring actions of team members to reduce workload and errors Typically lead team events Monitor teammates with I’M SAFE Brief – planning Illness Huddle – problem solving Medication Debriefs – process/improve Stress Alcohol and drugs Fatigue Eating and elimination  TEAM STEPPS Communication Hand-offs: I PASS the BATON SBAR Introduction Situation Patient Background Assessment Assessment Situation Recommendation Safety Background Actions Timing Ownership Next  Mutual Support Two-Challenge Rule: responsibility to vocalize concern at least twice Then escalate if still concerned TEAM STEPPS Use DESC for conflict resolution Describe Express Suggest Consequences THANK YOU!