Comp1_unit1_discuss_key.doc - Lane Community College



Introduction to Healthcare and Public Health in the US: Introduction and History of Modern Healthcare in the US

Discussion Questions

Lecture a

1. What is health? What is healthcare?

Expected outcomes of discussion:

Elicit appropriate definition of “health” – often thought of as the absence of disease

WHO definition: Health is defined as the “…state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.

Elicit appropriate definition of “illness” - a state of poor health

Elicit appropriate definition of “healthcare” -- the prevention and treatment of illness

Objective(s): 1

Slide(s): 3, 4

2. Who delivers healthcare services?

Expected outcomes of discussion:

Healthcare is delivered by different people from different disciplines. Encourage students to come up with different disciplines associated with healthcare, including

Medicine

Dentistry

Nursing

Laboratory Science

Pharmacy

Other allied health professions

Discuss the concept of “interdisciplinary teams” where health care workers collaborate to deliver care

Objective(s): 1

Slide(s): 4

3. Compare and contrast inpatient and outpatient facilities?

Expected outcomes of discussion:

Compare inpatient and outpatient facilities, focus discussion in the context of patient volumes, cost, presence of ancillary services

Inpatient facilities - hospitals and other residential care settings

Outpatient facilities - patient care in the community

Objective(s): 1

Slide(s): 6, 7, 8, 9

4. What are hospitals? What are the different pathways by which patients can be admitted to a hospital?

Expected outcomes of discussion:

Institutions for treating sick or injured people

Admissions via ED or as direct admits

Objective(s): 1

Slide(s): 6

5. What type of nursing/residential care facilities would be most appropriate for:

(a) a patient who has recently undergone hip replacement surgery whose orthopedic surgeon thinks he can go back to living at home in a few months, and

(b) a patient with advanced Alzheimer’s dementia?

Expected outcomes of discussion:

(a) short term nursing/residential care

(b) long term nursing/residential care

Objective(s): 1, 2

Slide(s): 7, 8

6. Can you name different types of ambulatory health care services?

Expected outcomes of discussion:

Physicians’ offices

Primary care offices

Specialty care offices

Single specialty or multispecialty offices

Dental offices

General dentists or specialists

Medical and diagnostic laboratories

Other ambulatory health services

Objective(s): 1

Slide(s): 9

7. Consider the statement: “although hospitals constitute only 1 percent of all healthcare establishments, they employ 35 percent of all healthcare workers”?

What is it about hospitals that make them employ such a large percentage of healthcare workers?

Expected outcomes of discussion:

Healthcare is labor intensive, and there are many roles for workers in hospitals associated with direct and indirect patient care. A hospital is a high volume concentrated area of patients as compared to other healthcare establishments. A hospital has many departments and sections.

Objective(s): 2, 3, 5

Slide(s): 10, 11

8. What is a healthcare system? Describe different models of healthcare systems.

Expected outcomes of discussion:

A healthcare system is an organization to deliver health care.

Models of healthcare systems include:

Purely public (care conducted by the state)

Purely private (care conducted by independent, privately funded organizations)

Often a mixed model

Objective(s) 1, 2

Slide(s): 12, 13

9. Can you suggest some benchmarks to measure healthcare systems? Defend your choices.

Expected outcomes of discussion:

Different sets of benchmarks can be discussed based on clinical, financial, social, economic, and outcome-based factors. One example of a set of benchmarks includes attention to:

Patient assessed value

Performance on clinical interventions

Efficiency

Objective(s): 2

Slide(s): 16

Lecture b

1. What is public health?

Expected outcomes of discussion:

Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals."

Objective(s): 1

Slide(s): 3

2. Name some of the significant public health achievements in the US in the 20th century.

Pick an example of a public health achievement that you consider to be impressive, and present your findings to your class.

Expected outcomes of discussion:

Significant public health achievements in the US in the 20th century include:

Vaccination

Motor-vehicle safety

Safer workplaces

Control of infectious diseases

Decline in deaths from coronary heart disease and stroke

Safer and healthier foods

Healthier mothers and babies

Family planning

Fluoridation of drinking water

Recognition of tobacco use as a health hazard

There are many other achievements that can be detailed.

Objective(s): 4

Slide(s): 4

3. What is epidemiology? How does it help medicine?

Expected outcomes of discussion:

Epidemiology is a quantitative basic science, a method of causal reasoning based on developing and testing hypotheses pertaining to occurrence and prevention of morbidity and mortality, and a tool for public health action to promote and protect the public’s health. Epidemiology allows the use of reasoning and deductive skills to reduce morbidity and mortality.

Objective(s): 1, 4

Slide(s): 9

4. There have been multiple confirmed cases of Disease X in your community.

You suspect that the disease is caused by long-term consumption of a particular food item. How would you begin to collect data that would help you prove your hypothesis? How would you want to analyze this data?

Expected outcomes of discussion:

Methods for data collection – surveys, prospective and retrospective studies. Randomization of subjects and the establishment of a control differentiates a true experiment from quasi-experiments. Data analysis using proven statistical methods.

Objective(s): 2, 4

Slide(s): 11, 12

Lecture c

1. Do you think that health care expenditure in the US is high? If so, why? If not, defend your position.

Expected outcomes of discussion:

Health care expenditure is $2.3 trillion in 2008 (16.2% of GDP, $7681 per resident) -- definitely high!

Objective(s): 5

Slide(s): 3

2. What are the options for financing healthcare in the US? Which do you think is the most effective when considering the entire population of the US?

Expected outcomes of discussion:

Healthcare can be financed using:

general revenue

social health insurance

voluntary or private health insurance

out-of-pocket payments

internal donations

Objective(s): 5

Slide(s): 3

3. Discuss the cultural shift in medicine that led from physician-centric to patient-centric care – from paternalism to patient autonomy. Which model of care delivery would you prefer your own physician to use? Why?

Expected outcomes of discussion:

A majority of patients prefer patient-centricity and autonomy to make their own decisions.

Objective(s): 5

Slide(s): 5

4. Discuss the reasons why care of patients has shifted from an individual to a team-based approach.

Expected outcomes of discussion:

Shift driven predominantly by the increasing complexity of healthcare delivery, and patient disease patterns.

Objective(s): 5

Slide(s): 6

5. What is a patient centered medical home? Why do you think that this model of care is finding increasing acceptance by clinicians?

Expected outcomes of discussion:

Increasing acceptance due primarily to the ability of the model to address the care of complex patients with multiple diseases.

Objective(s): 5

Slide(s): 7

6. Discuss some of the advantages and disadvantages of the dominance of technology in healthcare delivery.

Expected outcomes of discussion:

Advantages: improvements in care, patient safety, outcomes, diagnosis, and management. Disadvantages: increasing technology increases cost, complexity of healthcare delivery.

Objective(s): 5

Slide(s): 9

7. What is the structure of public health services in your town/city and state?

Expected outcomes of discussion:

Students can discuss their own state and local public health departments.

Objective(s): 1, 2

Slide(s): 6-10

Lecture d

1. What, in your opinion, are the advantages and disadvantages of maintaining patient medical records in an electronic, as opposed to a paper-based format?

Expected outcomes of discussion:

Advantages:

Remote access to patient data

Record is legible

Confidentiality is better handled than paper records

Improves patient safety

Integration with other resources and data

Integration with decision support and knowledge-base resources

Disadvantages:

Cost of installation, maintenance and upgrading

Requires training and changes in clinical workflows

Lack of interoperability

Depersonalizes the doctor-patient relationship

Objective(s): 4

Slide(s): 3, 4

2. What is a personal health record?

Consider personal health products – take a tour of Microsoft HealthVault at . Do you think that use of personal health records will become universal, or will they become unfashionable and extinct over time? (web site accessed on 12/8/2011)

Expected outcomes of discussion:

Personal health records - patients keep their own medical records. Despite some concerns, there has been a steady increase in the number of patients who use PHRs.

Objective(s): 1, 4

Slide(s): 5,6

3. Give examples of the use of technology in the inpatient and the outpatient settings.

How do they help (a) patients, and (b) clinicians?

Expected outcomes of discussion:

Technology in the medical office (billing, claims processing, scheduling, EHR)

Technology in the hospital (pharmacy informatics, diagnostic imaging, robotic surgery)

Telemedicine and telecare

Technology to improve information retrieval and education

Objective(s): 4

Slide(s): 5,6,7,8,9,10,11,12

4. How can clinical decision support improve patient safety?

Expected outcomes of discussion:

Reminders and alerts help clinicians avoid errors

Checks for drug-drug interactions

Reviews orders, scans for inconsistencies

Objective(s): 1, 4

Slide(s): 9

5. Consider that you inhabit an alternate universe where radiology does not exist as a medical specialty. Discuss the disadvantages of not having this technology both from the perspective of the physician and the patient.

Expected outcomes of discussion:

Radiology has become an essential tool for diagnosis, greatly benefiting both patients and physicians.

Objective(s): 4, 5

Slide(s): 11

6. What is assistive technology? Can you give some examples of assistive devices?

Expected outcomes of discussion:

Examples of assistive technology

Audio books and text-to-speech

Voice recognition software

Prosthetics

Wheelchairs and ambulatory devices

Objective(s): 1, 4

Slide(s): 12

7. List some of the online resources that can be used in the practice of medicine. How do you think online resources have helped advance medical education?

Expected outcomes of discussion:

Expert systems help in developing diagnostic reasoning skills

Online resources provide a readily available knowledge base that can be accessed on-demand

Simulation technology helps in training

Objective(s): 4

Slide(s): 13

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