Epi Midterm
Health care mnagers should be concerned about healthcare-associated infections because: (select all that apply) -They cause suffering to the patient -They improve patient outcomes -They are costly to the healthcare organization -They may result in the patient's death
- They cause suffering to the patient - They are costly to the healthcare organization -They may result in the patient's death
Refer to the Healthy People 2030 website and list the 4 practical ways Healthy People 2030 can help you improve health and well-being through your work.
1. identify needs and priority populations 2. set your own targets 3. find inspiration and practical tools 4. monitor national progress and use the data as a benchmark
100 students eat lunch in Hogan Dining Hall on Wednesday and 15 become ill with diarrhea and vomiting by the evening. Calculate the crude attack rate and type your answer as a %.
15x100/100= 15%
An epidemiologic investigation that began on January 1, 2020, identified a population of 1,000 people among whom four were found to have congestive heart failure on this date. During the year of the study, six additional new cases were found. Among the 10 cases, there were seven deaths during the year. There were no deaths among the remaining 990 people. What was the point prevalence rate on February 1, 2020? Express your answer per 1,000 people.
6 per 1,000
With 100 new cases of heart disease in 2020 in a population of 2,000, and 400 existing cases at the end of 2019, and no deaths, what is the 2020 incidence rate per 100?
6.25
An epidemiologic investigation that began on January 1, 2020, identified a population of 1,000 people among whom four were found to have congestive heart failure on this date. During the year of the study, six additional new cases were found. Among the 10 cases, there were seven deaths during the year. There were no deaths among the remaining 990 people. What was the mortality rate during 2020? Express your answer per 1,000 people
7 per 1,000
An epidemiologic investigation that began on January 1, 2020, identified a population of 1,000 people among whom four were found to have congestive heart failure on this date. During the year of the study, six additional new cases were found. Among the 10 cases, there were seven deaths during the year. There were no deaths among the remaining 990 people. What was the case fatality rate during 2020? Express your answer as a %.
7/10= 70%
Refer to Exhibit 7.9 to answer the following question. After indirect standardization, which state has comparatively lower mortality compared to the US?
Alaska and Florida Both states have a lower SMR (86.5 and 92.4) than the US SMR (100).
Refer to Exhibit 7.9 to answer the following question. After indirect standardization, which state has comparatively lower mortality?
Alaska's SMR (86.5) is lower than Florida's SMR (92.4)
Which of the following are examples of potential situations address in contingency planning? (select all that apply) -Assuring the safety of patients during an active shooter event -Assuring adequate staffing to respond to an increased influx of patients during an epidemic -Guaranteeing the continuity of health services during a hurricane -Planning the future strategic direction of a healthcare system during economic turmoil
Assuring the safety of patients during an active shooter event Assuring adequate staffing to respond to an increased influx of patients during an epidemic Guaranteeing the continuity of health services during a hurricane
Why is institutional planning considered easier than community planning?
Because institutional planning has fewer stakeholders, more focused interests, and more control of resources and actions.
Which of the following are examples of valuable sources of morbidity statistics. (select all that apply) -CDC's Morbidity and Mortality Weekly Report -UPMC clinical records -National Health and Nutrition Survey -Allegheny County COVID-19 Dashboard
CDC's Morbidity and Mortality Weekly Report UPMC clinical records National Health and Nutrition Survey Allegheny County COVID-19 Dashboard
What was the third leading cause of death in the US for the year 2020?
COVID-19
An epidemiologic investigation that began on January 1, 2020, identified a population of 1,000 people among whom four were found to have congestive heart failure on this date. During the year of the study, six additional new cases were found. Among the 10 cases, there were seven deaths during the year. There were no deaths among the remaining 990 people. What was the point prevalence rate on May 1, 2020? express your answer per 1,000 people.
Cases 1, 2, 3, 5, 7, 8 = 6/(1,000 - 2) = (6/998)*1,000 = 6.01 per 1,000. Note that cases 4 and 6 were dead on May 1, therefore these deaths need to be subtracted from the denominator since those people were not alive and present on this date.
Refer to Exhibit 7.6 to answer the following question. What region has the highest heart disease mortality rates? -New England -Deep South -Pacific Northwest -Mountain West
Deep South
Which of the following are factors that contribute to errors in reporting the cause of death? (select all that apply) -Difficulty to diagnose some diseases -Stigma related to a particular cause of death -Intentional misclassification of the cause of death -Inexperience of physicians completing death certificates
Difficulty to diagnose some diseases Stigma related to a particular cause of death Intentional misclassification of the cause of death
Explain why epidemiologists commonly standardize for age when comparing populations.
Epidemiologists standardize for age in a direct method that can compare age-specific deaths. This way they can calculate the leading cause of death in each age group and compare.
Refer to Exhibit 7.9 to answer the following question. Which state had the most expected deaths in 2017?
Florida
What are 4 important criteria to consider when determining if a specific infection should be a focus of a hospital surveillance system?
Focus on infections that: are frequent are preventable generate high costs have serious effects on morbidity or mortality
According to the results of Case Study 6.1. MRSA Surveillance at University Hospital, which group had the highest rate of MRSA carriers identified after the intervention was implemented?
Geriatric, 204.0 per 1,000 admissions
The relationship between mortality and age is best characterized by which kind of curve? - Backwards L -L -J - U
J
Which of the following are examples of antibiotic-resistant pathogens? (select all that apply) -Hepatitis -MRSA -VRE -COVID-19
MRS VRE
What is the definition of morbidity?
Morbidity is a disease that is prevalent in people of any age group that include acute and chronic conditions.
Which of the following is an example of a specific mortality rate? -PA infant mortality rate for 2020 -UPMC SMR rate for CABG for February 2021 -Pittsburgh maternal mortality ratio for 2019 -US mortality rate for 2020
PA infant mortality rate for 2020
Criteria for a good screening program include: (select all that apply) -Test detects disease at earlier stage -Test is acceptable to the patient -There is no treatment options for patients who test positive -Test has high specificity and low sensitivity
Test detects disease at earlier stage Test is acceptable to the patient
Which of the following are examples of how epidemiology is used in quality assurance? (select all that apply) Use epidemiologic tools to measure quality Create the quality improvement system Six Sigma Provide a means to compare quality indicators between groups Epidemiology is not used in quality assurance
Use epidemiologic tools to measure quality Provide a means to compare quality indicators between groups
According to the results of Case Study 6.1. MRSA Surveillance at University Hospital, did the rate of Nosocomial MRSA bacteremia cases decrease after intervention? Justify yout answer with data.
Yes, the overall rate of Nosocomial MRSA bacteremia cases decreased after intervention going from 0.74 per 1,000 admissions (before intervention) to 0.37 per 1,000 admissions (after intervention).
What is an ambulatory care-sensitive condition? -a condition that ought to be treated outside the hospital -a serious medical condition -a condition that cannot be treated in the hospital -a condition that needs to be treated in the hospital
a condition that ought to be treated outside the hospital
What is an avoidable hospitalization? -a hospitalization that could be prevented through appropriate outpatient care -a readmission related to a previous hospitalization -a hospitalization that could be prevented by reducing length of stay -a hospitalization refused by a managed care gatekeeper
a hospitalization that could be prevented through appropriate outpatient care
Which of the following is NOT an example of an action that promotes the development of antibiotic resistance? -A nurse questions an antibiotic prescription because of the dose prescribed -A farmer gives antibiotics to his cattle so they increase their weight faster -A patient stops taking an antibiotic a week early after feeling better -A primary care provider prescribes an antibiotic for the common cold
a patient stops taking antibiotic a week early after feeling better
Signs and symptoms become "obvious" during which of the following phases? -acute -prodrome -incubation -resolution
acute
Which of the following was NOT one of pillars of population health identified by Nash (2012)? -acute care management -chronic care management -health policy -public health
acute care management
What are the key components of the epidemiologic triad? -time, distribution, determinants -study design, variables, -statistical methods -vector, agent, host -agent, host, environment
agent, host, environment
Mortality is an essential indicator for -Prioritizing interventions -Assessing quality of care -Determining patterns of disease -All of the above
all of the above
The 4 most common healthcare-associated infections include: (select all that apply) -ventilator-associated infection -vascular catheter-associated infection -Needle stick infections -surgical site infection -urinary tract infection -COVID-19
all of the above
Whick of the following are examples of social determinants of health? (select all that apply) -the availability of medical care in a city -low levels of community violence -living in a food desert - all of the above
all of the above
Which of the following is NOT expressed as a rate per 1,000 live births? -infant mortality rate -neonatal mortality rate maternal mortality rate -All of the above actually are expressed as a rate per 1,000 live births
all of the above actually are expressed as rate per 1,000 live births
Which of the following are associated with age as a determinant? -variation in lifestyle -immunological status -progressive diseases - all of these
all of these
In terms of heath and mortality, which group generally has the best health indicators? -Blacks -Whites -Native Americans -Asians
asians
In the United States at least, higher income or wealth is associated with which of the following? -better health but decreased longevity -worse health and decreased longevity -better health or increased longevity -worse health but increased longevity
better health or increased longevity
Because duration of stay in the hospital is a risk, how could we control for that in our calculations? -by using admissions in the denominator for rates -by using average length of stay in the denominator for rates -by using patient days in the denominator for rates -by using discharges in the denominator for rates
by using patient days in the denominator for rates
Which of the following are risk factors that can be used in risk-adjusted mortality rates? (select all that apply) -comorbidities -gender -age -Genetics
comorbidities gender age
What is an illness that exists before, or arises after, the hospital stay and is not related to the stay? -primary diagnosis -complication -comorbidity -underlying illness
comorbidity
Which of the following measures of quality is most sensitive and related to process of care -complication rates -mortlity rates -structural measures such as nurse/patient ratio -case fatality rates
complication rates
Which of the following is a quality improvement tool that depicts trends over time, with confidence intervals? -histogram -control chart -Pareto chart -run chart
control chart
An infectious person recovering from disease is referred to as which kind of carrier? -intermittent carrier -incubatory carrier -lingering carrier -convalescent carrier
convalescent carrier
Which of the following represents the overall number of deaths divided by the number at risk of dying, expressed as a rate? -crude mortality rate -case fatality rate -specific mortality rate -adjusted mortality rate
crude mortality rate
When age-specific death rates from the two population groups to be compared are each applied to a third reference group, this is called which of the following? -sequential standardization -indirect standardization -reference standardization -direct standardization
direct standardization
According to Parrish (2010), poverty would be which kind of a factor affecting population health outcomes? -distal -associated -physiologic -proximal
distal
What is the most important risk factor for a catheter-associated urinary tract infection? -type of catheterization -sex -duration of catheterization -age
duration of catheterization
The population of Lexington, Kentucky, would be referred to as which of the following? fixed population dynamic population fixed cohort dynamic cohort
dynamic population
Which of the following is an example of a fomite responsible for disease transmission? -Impure water -Microorganisms -Mosquitos -Eating utensils
eating utensils
Two students in the dorm develop colds in November. This level of disease is called which of the following? -basic reproduction level -endemic level -epidemic level -stability level
endemic level
Which of the following is the occurrence of disease in a population in excess of what is normally expected? -disease cluster -epidemic -pandemic -endemic
epidemic
The incubation period is the time interval between _________ and ____________? -exposure and diagnosis -symptoms and disability -symptoms and diagnosis -exposure and symptoms
exposure and symptoms
Generally speaking, global mortality data is unreliable. -true -false
false
In the natural history of disease, it is better to reach the critical point before the clinical horizon. -true -false
false
Refer to Exhibit 7.7 to answer the following question. By looking at the map, we can conclude that the absolute number of stroke deaths in Alaska is more than the absolute number of stroke deaths in California. - true -false
false
Screening tests and diagnostic tests serve the same purpose. -true -false
false
The HR Director presents the distribution of COVID-19 infections among staff for the month of August to the executive leadership team. This is an example of Analytic Epidemiology. - true -false
false
Uncontrolled circulation of the SARS-CoV-2 virus in humans will decrease the number of new variants. -true -false
false
Which of the following categorizes the potential causes of process problems? -scatter diagram -Pareto chart -fishbone diagram -control chart
fishbone diagram
Which of the following would NOT be a component of socioeconomic status? -income -occupation -functional status -education
functional status
The "meanings and social arrangements that create different experiences [for men and women]" refers to which of the following? -sex -both gender and sex -gender -neither gender nor sex
gender
According to Porta (2014), what is a "collective or individual risk factor (or set of factors) that is causally related to a health condition, outcome, or other defined characteristic"? -health disparity -health determinant -health outcome - population health outcome
health determinant
What is defined as "preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations"? health disparity quality of care metric heath determinant health outcome
health disparity
Reduce infant mortality deaths to no more that 9 deaths per 1,000 live births ia an example of: -risk reduction objective -crude mortality rate -health status objective -age adjusted mortality rate
health status objective
Which of the following are infections acquired while receiving healthcare for another condition? -agent infections -healthcare-associated infections -vehicle-borne infections -vector-borne infections
healthcare-associated infections
What was the leading cause of death in the United States in 2017? -cancer -pneumonia -heart disease -diabetes mellitus
heart disease
Which of the following is NOT an AHRQ patient safety quality indicator? -birth trauma rate injury to neonate -heart failure mortality rate -pressure ulcer rate -postoperative sepsis rate
heart failure mortality rate
Which of the following describes the resistance of a group of people to the invasion and spread of disease? -primary prevention -secondary prevention -quarantine -herd immunity
herd immunity
A person or animal in which a parasite or infectious agent lives is called which of the following? -vehicle -agent -host -vector
host
In Capstone Case D: Needs Assessment for Stroke, the best epidemiological measure we could use to estimate the need for services for acute stroke cases is: -Prevalence -Incidence
incidence
New cases of disease are measured by which type of rates? -point prevalence -prevalence -case fatality -incidence
incidence
With what method of standardization is the standardized mortality ratio (SMR) used? -indirect standardization -reference standardization -sequential standardization -direct standardization
indirect standardization
Which of the following is a needs assessment method? (Select all that apply)
inferential indicators key informant survey community survey demographic analysis
For the healthcare organization, population at risk could be defined in terms of: (select all that apply) -inpatient episodes (e.g., admissions) -units of time (e.g., patient days) -enrolled members (e.g., MCOs) none of these are correct
inpatient episodes (e.g., admissions) units of time (e.g., patient days) enrolled members (e.g., MCOs)
Quality standards that relate to the relatively stable characteristics of the providers of care, the settings in which they practice, and the resources that they use are called which one of the following? process standards turnover standards output standards input standards
input standards
Fill in the blank: Education is __________________ associated with mortality. - inversely - exponentially - directly - not
inversely
If the prevalence of a disease has been relatively constant for the past ten years (i.e., new cases have been balanced by cures or deaths of prevalent cases), and recently the disease can be treated with newer drugs that prolong the life of the cases, how would the use of these drugs affect the prevalence of the disease? -It would increase the prevalence -It would only increase the cumulative incidence and have no effect on the prevalence -It would have no effect on prevalence as the prevalence has been constant. -It would decrease the prevalence
it would increase the prevalence
Which of the following are considered relatively inexpensive needs assessment methods? (Select all that apply) -community survey -key informant survey -inferential indicators -demographic analysis
key informant survey inferential indicators demographic analysis
Fill in the blank: Higher occupational status is associated with _________________mortality. -no difference in -much greater -lower -higher
lower
With regard to breast cancer, black women have which of the following? -higher incidence and higher mortality -lower incidence and lower mortality -higher incidence but lower mortality -lower incidence but higher mortality
lower incidence and higher mortality
Which of the following are components of a plan? (select all that apply)
means resources control ends
According to the Johns Hopkins University School of Medicine study covered in class, what is the third leading cause of death in the U.S.?
medical errors
In Capstone Case D: Needs Assessment for Stroke, the risk factors we would assess to determine the need for services can be classified as: Modifiable risk factors Non-modifiable risk factors
modifiable risk factors
Hispanics tend to have which of the following? -less disability but shorter longevity -more disability but greater longevity -more disability and shorter longevity -less disability and longer longevity
more disability but greater longevity
According to Donabedian (1973), which of the following represents the amount of medical services that SHOULD be consumed? need want demand utilization
need
Which of the following is a measure that includes death, loss of function, and lack of well-being? -clinical outcome -positive health outcome -negative health outcome -functional status
negative health outcome
When a strain of the influenza virus infected one-fifth of all people in the world in 1918, it became defined as which type of disease? -endemic -global -epidemic -pandemic
pandemic
what does one call the distribution of health outcomes within a population, the determinants that influence distribution, and the policies and interventions that affect those determinants? - population health - public health -epidemiology - health services management
population health
Of those who test positive, the percent who actually have the disease is called which of the following? -positive predictive value -sensitivity -specificity -reliability
positive predictive value
In Capstone Case D: Needs Assessment for Stroke, the best epidemiological measure we could use to estimate the need for services for major sequelae after stroke is: -Prevalence -Incidence
prevalence
With total quality management, the main source of quality problems is which of the following? -people -process -outcomes -structure
process
Select the three categories of common quality of care methods: -Process -Outcome -Epidemiology -Structure
process, outcome, structure
In healthcare marketing what would we call "activities to acquaint the prospective patient with the organization and the services it offers"? -differentiation -promotion -product -place
promotion
Which of the following indicates the percent of people with a disease who test positive? -positive predictive value -specificity -sensitivity -validity
sensitivity
When you retest a group of patients who test positive or negative with a second test, this is called which of the following? -diagnostic testing -double-blind testing -sequential testing -screening
sequential testing
Which of the following indicates the percent of people without the disease who can be ruled out as being disease-free? -specificity -validity -negative predictive value -sensitivity
specificity
The comprehensive, long-range planning process that often includes the vision, mission, goals, and objectives of an organization is called which of the following? -operational planning -assessment planning -contingency planning -strategic planning
strategic planning
Along the natural history of disease, what is the clinical horizon? -the point at which signs and symptoms make a disease detectible -the point at which the disease is diagnosed -the point at which the disease becomes detectable through technology such as -the moment when the patient is exposed to a risk factor
the point at which signs and symptoms make a disease detectible
You calculate the uterine cancer incidence rate but include females with hysterectomies in the denominator. If you exclude those females, what will happen to the rate? -The rate will decrease -The rate will stay the same -The rate will increase
the rate will increase
Suppose that the critical point of a disease occurs before the subclinical horizon. Which one of the following is true? -The screening test would be somewhat useful -The screening test would be very useful -The screening test would prove that the subclinical horizon is the same as the clinical horizon -The screening test would be useless
the screening test would be very useful
Infant mortality and maternal mortality are widely used indicators for comparison (within and between countries) and are directly related to healthcare access and quality. -true -false
true
It is important for healthcare managers to examine the best scientific evidence and openly communicate with personnel while considering whether to mandate COVID-19 vaccination for hospital staff. - true -false
true
Most control activities relate to either quality or financial management. -true -false
true
Most countries in the world have agreed to track mortality. -true -false
true
Recognizable patterns of disease tend to occur in different age groups. - true - false
true
The Patient Protection and Affordable Care Act of 2010 (ACA) requires tax-exempt hospitals to create a hospital CHNA every three years, and healthcare managers are often tasked with supporting this requirement true false
true
The U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. The Task Force works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services. true false
true
The basic reproduction number (R0) is a well-known epidemiological concept to measure the spread of an infectious disease. It is defined as the average number of secondary cases that one primary case will generate in a given population, where nobody is either immune or vaccinated. The estimated R0 of the Delta Variant is much higher compared to the original SARS-CoV-2 that was identified in Wuhan, China. - true -false
true
The measurement of quality, outcomes, or value should play an important role in a population health model, regardless of whether the population is a large geographic area with boundaries-such as a state, county, or city-or a population less well defined geographically but rather by membership, admission or encounters, such as a managed care organization (MCO), a hospital, or a physician practice. -true -false
true
The Queen's Health Policy Research Unit (QHPRU) determined that pharmacologic intervention would be appropriate for 142,000 people with high blood pressure, but only 137,000 people were actually provided these drugs. The difference between these two numbers is referred to as what? -overmet need -need -unmet need -utilization
unmet need
What is the need in the population for services that are not currently being provided by the healthcare system called? -basic need -unmet need -underutilization need -unrecognized need
unmet need
Which of the following would be considered an extrinsic risk of hospitalization? -patient immunodeficiency -ventilators -patient age -comorbidities
ventilators
Is it possible to standardize by more than one variable?
yes