Managerial epidemiology

Last updated

The use of epidemiological tools in health care management can be described as managerial epidemiology. Several formal definitions have been proposed for managerial epidemiology. These include:

Contents

History

The potential value of epidemiology in health care management has long been recognized. [4] [5] [6] Academics were encouraging use of epidemiological methods in health care management for quality improvement and planning before the term ‘managerial epidemiology’ was coined. (See for example Rohrer 1989. [7] ) Epidemiology became a required subject in some health care management programs and textbooks were written for those courses. Managerial epidemiology might be considered a type of health services research, since it involves the study of health services.

After almost 40 years of research, a handful of researchers provided examples of using managerial epidemiology and the importance for healthcare managers to use the practice. However, the perspectives of healthcare leaders on the use of managerial epidemiology were never studied until 2020. In 2020, a study was conducted to explore the adoption of managerial epidemiology by ambulatory healthcare leaders across the United States (See Schenning 2020 [8] [9] ). The adoption was found to be poor; yet, critically important for improving overall health system performance including the triple aim and impacting population health. From the findings, Dr. Schenning developed a framework for accelerating adoption of managerial epidemiology (See Schenning 2020). She also discussed the importance of using managerial epidemiology for pandemic preparedness and response.


Variations

An important distinction can be drawn between population epidemiology and clinical epidemiology. If the US health care system had fully evolved in a direction that entailed management of care for populations rather than patients, then the concepts, methods and perspectives drawn from population epidemiology would have been ideal tools for use by managers. This indeed was anticipated by authors of textbooks on managerial epidemiology. (See Dever [10] ). In each cycle of health reform, the utility of epidemiology in planning medical services for populations was recognized.[ citation needed ]

However, the attention of most health care managers remains focused on patients rather than communities. Hospitals do not serve enrolled populations; they serve the patients who are treated in their beds and in the clinics. Consequently, the tools and perspectives of clinical epidemiology may be as or more relevant to health care managers than those drawn from population epidemiology. Managers employing epidemiology in hospitals might not conduct many community surveys. Instead, they would extract clinical information from medical records to analyze variations in outcomes, complications, and services used.[ citation needed ]

However, healthcare leaders should use managerial epidemiology especially population epidemiology for population health strategies and overall system performance (See Schenning [9] ). This is seen with the rise in addressing social determinants of health and further realized during the COVID-19 pandemic (See Schenning [9] ).

Application

Methods drawn from clinical epidemiology that are employed in health care management to assess quality and cost include the following. [3]

  1. Study designs commonly used by epidemiologists, such as cohort studies, case control studies and surveys of patients.
  2. Measures commonly used by epidemiologists, such as morbidity rates, infection rates, and mortality rates.
  3. Statistical techniques commonly used by epidemiologists, such as chi square tests of rates and proportions.
  4. Stratification of data by health problem, diagnosis or disability so as to maximize biological and clinical homogeneity.

Differentiation

Managerial epidemiology differs from clinical epidemiology in that it addresses the concerns of management. For example, clinical epidemiologists who seek to control hospital-acquired infections would not be engaged in managerial epidemiology unless they described the infections as quality indicators and proposed or tested organizational changes that might reduce infection rates. Another distinction between clinical epidemiology and managerial epidemiology is that while clinical epidemiologists test the efficacy of particular treatments, managers are concerned with how clinical outcomes differ between hospitals, bed sections, clinics, or programs. Information of this kind can lead to reallocation of resources so as to improve efficiency and effectiveness of the organization as a whole. [3]

Related Research Articles

A health system, health care system or healthcare system is an organization of people, institutions, and resources that delivers health care services to meet the health needs of target populations.

<span class="mw-page-title-main">Epidemiology</span> Study of health and disease within a population

Epidemiology is the study and analysis of the distribution, patterns and determinants of health and disease conditions in a defined population.

<span class="mw-page-title-main">Clinic</span> Outpatient health care facility

A clinic is a health facility that is primarily focused on the care of outpatients. Clinics can be privately operated or publicly managed and funded. They typically cover the primary care needs of populations in local communities, in contrast to larger hospitals which offer more specialized treatments and admit inpatients for overnight stays.

<span class="mw-page-title-main">Hospital-acquired infection</span> Infection that is acquired in a hospital or other health care facility

A hospital-acquired infection, also known as a nosocomial infection, is an infection that is acquired in a hospital or other healthcare facility. To emphasize both hospital and nonhospital settings, it is sometimes instead called a healthcare-associated infection. Such an infection can be acquired in hospital, nursing home, rehabilitation facility, outpatient clinic, diagnostic laboratory or other clinical settings. A number of dynamic processes can bring contamination into operating rooms and other areas within nosocomial settings. Infection is spread to the susceptible patient in the clinical setting by various means. Healthcare staff also spread infection, in addition to contaminated equipment, bed linens, or air droplets. The infection can originate from the outside environment, another infected patient, staff that may be infected, or in some cases, the source of the infection cannot be determined. In some cases the microorganism originates from the patient's own skin microbiota, becoming opportunistic after surgery or other procedures that compromise the protective skin barrier. Though the patient may have contracted the infection from their own skin, the infection is still considered nosocomial since it develops in the health care setting. Nosocomial infection tends to lack evidence that it was present when the patient entered the healthcare setting, thus meaning it was acquired post-admission.

<span class="mw-page-title-main">Electronic health record</span> Digital collection of patient and population electronically stored health information

An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.

Disease management is defined as "a system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant."

<span class="mw-page-title-main">Population health</span> Health outcomes of a group of individuals

Population health has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group". It is an approach to health that aims to improve the health of an entire human population. It has been described as consisting of three components. These are "health outcomes, patterns of health determinants, and policies and interventions".

Infection prevention and control is the discipline concerned with preventing healthcare-associated infections; a practical rather than academic sub-discipline of epidemiology. In Northern Europe, infection prevention and control is expanded from healthcare into a component in public health, known as "infection protection". It is an essential part of the infrastructure of health care. Infection control and hospital epidemiology are akin to public health practice, practiced within the confines of a particular health-care delivery system rather than directed at society as a whole.

Health information management (HIM) is information management applied to health and health care. It is the practice of analyzing and protecting digital and traditional medical information vital to providing quality patient care. With the widespread computerization of health records, traditional (paper-based) records are being replaced with electronic health records (EHRs). The tools of health informatics and health information technology are continually improving to bring greater efficiency to information management in the health care sector.

Health services research (HSR) became a burgeoning field in North America in the 1960s, when scientific information and policy deliberation began to coalesce. Sometimes also referred to as health systems research or health policy and systems research (HPSR), HSR is a multidisciplinary scientific field that examines how people get access to health care practitioners and health care services, how much care costs, and what happens to patients as a result of this care. HSR utilizes all qualitative and quantitative methods across the board to ask questions of the healthcare system. It focuses on performance, quality, effectiveness and efficiency of health care services as they relate to health problems of individuals and populations, as well as health care systems and addresses wide-ranging topics of structure, processes, and organization of health care services; their use and people's access to services; efficiency and effectiveness of health care services; the quality of healthcare services and its relationship to health status, and; the uses of medical knowledge.

Molecular epidemiology is a branch of epidemiology and medical science that focuses on the contribution of potential genetic and environmental risk factors, identified at the molecular level, to the etiology, distribution and prevention of disease within families and across populations. This field has emerged from the integration of molecular biology into traditional epidemiological research. Molecular epidemiology improves our understanding of the pathogenesis of disease by identifying specific pathways, molecules and genes that influence the risk of developing disease. More broadly, it seeks to establish understanding of how the interactions between genetic traits and environmental exposures result in disease.

Tele-epidemiology is the application of telecommunications to epidemiological research and application, including space-based and internet-based systems.

Ambulatory care nursing is the nursing care of patients who receive treatment on an outpatient basis, ie they do not require admission to a hospital for an overnight stay. Ambulatory care includes those clinical, organizational and professional activities engaged in by registered nurses with and for individuals, groups, and populations who seek assistance with improving health and/or seek care for health-related problems. The American Academy of Ambulatory Care Nursing (AAACN) describes ambulatory care nursing as a comprehensive practice which is built on a broad knowledge base of nursing and health sciences, and applies clinical expertise rooted in the nursing process.

A depression rating scale is a psychometric instrument (tool), usually a questionnaire whose wording has been validated with experimental evidence, having descriptive words and phrases that indicate the severity of depression for a time period. When used, an observer may make judgements and rate a person at a specified scale level with respect to identified characteristics. Rather than being used to diagnose depression, a depression rating scale may be used to assign a score to a person's behaviour where that score may be used to determine whether that person should be evaluated more thoroughly for a depressive disorder diagnosis. Several rating scales are used for this purpose.

Clinical epidemiology is a subfield of epidemiology specifically focused on issues relevant to clinical medicine. The term was first introduced by Jean Paul in his presidential address to the American Society for Clinical Investigation in 1938. It is sometimes referred to as "the basic science of clinical medicine".

Transmission-based precautions are infection-control precautions in health care, in addition to the so-called "standard precautions". They are the latest routine infection prevention and control practices applied for patients who are known or suspected to be infected or colonized with infectious agents, including certain epidemiologically important pathogens, which require additional control measures to effectively prevent transmission. Universal precautions are also important to address as far as transmission-based precautions. Universal precautions is the practice of treating all bodily fluids as if it is infected with HIV, HBV, or other blood borne pathogens.

Antimicrobial stewardship is the systematic effort to educate and persuade prescribers of antimicrobials to follow evidence-based prescribing, in order to stem antimicrobial overuse, and thus antimicrobial resistance. AMS has been an organized effort of specialists in infectious diseases, both in Internal Medicine and Pediatrics with their respective peer-organizations, hospital pharmacists, the public health community and their professional organizations since the late 1990s. It has first been implemented in hospitals. In the U.S., within the context of physicians' prescribing freedom, AMS had largely been voluntary self-regulation in the form of policies and appeals to adhere to a prescribing self-discipline until 2017, when the Joint Commission prescribed that hospitals should have an Antimicrobial Stewardship team, which was expanded to the outpatient setting in 2020.

An infection rate is the probability or risk of an infection in a population. It is used to measure the frequency of occurrence of new instances of infection within a population during a specific time period.

Acoustic epidemiology refers to the study of the determinants and distribution of disease. It also refers to the analysis of sounds produced by the body through a single tool or a combination of diagnostic tools.

References

  1. ↑ Fos, PJ (2005). Managerial epidemiology for health care organizations . Jossey-Bass. pp.  4. ISBN   9780787981013.
  2. ↑ Evans, RG (1 June 1995). "Healthy populations or healthy institutions: the dilemma of health care management". Journal of Health Administration Education. 13 (3): 453–472.
  3. 1 2 3 Fleming, ST (2008). Managerial Epidemiology: Concepts and Cases. Ann Arbor: Health Administration Press.
  4. ↑ Fos, PJ; Fine DJ; Zuniga MA (1 December 1998). "Managerial epidemiology in the health administration curriculum". Journal of Health Administration Education. 16 (1): 1–12. PMID   10185497.
  5. ↑ Roper WL, WL; Cates W (1 September 1993). "Managerial epidemiology: the basic science for health reform". Journal of Health Administration Education. 11 (4): 621–627. PMID   10130248.
  6. ↑ Hunter, DJ (1 June 1998). "Public Health Management". Journal of Epidemiology and Community Health. 52 (6): 342–343. doi:10.1136/jech.52.6.342. PMC   1756720 . PMID   9764253.
  7. ↑ Rohrer, JE (1 June 1989). "The Secret of Medical Management". Health Care Management Review. 14 (3): 7–13. doi:10.1097/00004010-198901430-00002. PMID   2670836. S2CID   27952691.
  8. ↑ Schenning, C (2020). "The use of managerial epidemiology by healthcare leaders in ambulatory settings". Walden Dissertations and Doctoral Studies– via ProQuest.
  9. 1 2 3 Schenning, C (2020). "Use of managerial epidemiology by healthcare leaders in ambulatory settings". BMJ Open Quality. 9: A12.2–A12. doi: 10.1136/bmjoq-2020-IHI.10 . S2CID   234567496.
  10. ↑ Dever, GEA (2006). Managerial epidemiology: Practice, methods, and concepts. Jones and Bartlett Learning.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.