Lecturer: Monika M. Wahi, MPH, CPH
At the end of this lecture, student should be able to: Explain at least two ways in which technology can be used to improve access to care for a special population Describe at least three considerations that should be taken into account when trying to minimize the cost and maximize the benefit of medical technology Describe at least one special population, what special needs it has, and what the health care system must consider in meeting those needs
Impact of Medical Technology
Improved diagnosis and treatments Improved sanitation, nutrition, living conditions Life expectancy almost doubled from 1900 to 1965 Research and development (R&D) has led to these advances
Tech Cost- containment Growth
Canada Supply-side rationing • Limit number of MRI machines in a particular area U.S. Market • Consumer expectations must be met • Offer specialized procedures in outpatient • Medical training more complicated • These pressures = excessive equipment/treatment, increasing cost
• Open-heart surgery • Tissue transplants Medical Procedures • Hip and knee replacements • CT and MRI Diagnostic Equipment Equipment Devices • Lithotripter • Heart and lung machine to Render • Kidney dialysis machine Treatment • Pacemaker
• End-of life issues • Informed consent issues • Questions of rationing
And Information Technology
Facilities and Organizational Systems Medical Managed Information Patient care centers and Laboratories care systems management systems networks From Exhibit 5.1 on page 108.
Facilities and Organizational Systems Electronic Distance Internet E-health Telemedicine medical education records From Exhibit 5.1 on page 108.
• Computer- • Payroll, Retail ized billing, staff Home Health Physician scheduling, Health Clinics Order Entry budget/ Admini- Clinical (CPOE) cost control strative Inform- Medical Inform- ation ation Systems Systems Emergency (or Health) Pharmacy Room Internet Decision Informatics and E- Support health Systems Appli- Military • Forecasts, • Virtual cations Treatment Prisons alerts, visits, Facilities predictions, patient suggestions portals
• 2002 survey – half • Provides diagnosis/ Tele- • Collection/storage treatment when of all Americans medicine of health provider and patient looked for health and information are separated at a information online Remote Services • Immediate access distance • AMA survey – 86% • Slow adoption for authorized users of U.S. physicians • Knowledge = The Internet and e- (except for use the internet to decision support, ↑ health diagnostic/ obtain medical and quality, ↓ cost consultative prescription drug teleradiology) • ↑ efficiency in information. • Remote health health care delivery • Patient gateways Electronic Health Records services
How could Health IT Increase Prevent/ More safety improve these? delay complete of tx disease care onset Increase QoL Minimize side More effects Quicker accurate cure dx Faster Increase life recovery expectancy How could Health IT from mess these up? surgery From Exhibit 5.4 (page 119)
Expertise in Manage- Privacy/confidentiality ment Inter-operability Regulations/laws – how to maintain quality of care Return on investment (ROI) Nursing! Appropriate functions for setting? Market pressure from industry Expectations from patients vs. cost of functionalities Good management is the key to Expertise in seeing an ROI from health Informatics IT/medical informatics
• High capital costs (R&D, precision manufacturing) • Training/special skills • Facilities may require refurbishing • Higher utilization when covered by insurance (moral hazard/provider- induced demand) • Replacement of earlier, more expensive procedures • Minimally invasive procedures that eliminate the need for overnight hospital stays • Technologies that shorten hospital stays From Exhibits 5.5 and 5.6 (pages 120-121)
• Does it • Equal to or “break” things better than that were standard of working care? before? Efficacy • Intended • Does it results introduce new achieved? errors? • Does it save Cost- money Safety Effective- anywhere in ness the system? How much? • When do we get our ROI?
Have you ever worked somewhere (esp. health care) or received care somewhere where they Good management is added technology, and you were pretty sure it the key to seeing made things worse? Less safe, possibly? an ROI from health More expensive, possibly? Nursing has been IT/medical More error prone? known to excel in If managers did a “health technology assessment” informatics management and of how the above went, what do you think they would find? health IT/informatics Do you know why managers tend to avoid doing these “health technology assessments?”
Improve operations Improve safety Contain cost Optimize care/value Standardize care Improve access to care
Cost in making/implementing laws/regulations (FDA) Competition from providers drives up costs Medical training and research create demand American customers demand, and insurance supplies ROI not demonstrated for a variety of reasons
Technology can have good or bad effects on the U.S. health care system, depending upon how it is implemented Not only is it important to plan for an ROI when implementing new health technology, but to also do a health technology assessment after implementing it Good management is the key to seeing an ROI from health IT/medical informatics Conversely, bad management is the key to wasting money and putting patients in danger
Populations with Special Health Needs
• Mental • Racial health /ethnic Predis- • Chronic Need char- posing Predisposing illness/ Character acter- Character -istics dis- istics -istics Enabling ability • Gender • HIV/ and age Need AIDS • Geo- Enabling graphic Characteristics location From Exhibit 11.1 (page 263) • Insurance status • Homelessness
“Disparities” (a disproportionate amount compared to whites) in Health outcomes (e.g., life expectancy) Enabling characteristics (e.g., literacy, access to health care) How does Race/Ethnicity lead to disparities? Mainly environmental stressors: racism, poverty, poor food quality, lack of time to exercise, stressful life circumstances Rarely biological relationships (e.g., African American race linked to sickle cell trait)
WOMEN AND CHILDREN GLBT POPULATIONS Women have a higher Not mentioned in text, but mental illness rate than very important group men High adolescent suicide rate Attributed to stress from Only recently achieved sexism (lower pay), other measure of civil rights environmental sources Still much medical “New morbidities” for discrimination against children transgendered individuals Drug/alcohol abuse Obesity and type II diabetes Unique health needs Other mental health, learning Lesbians and birth control? disabilities Gay men and HIV?
Rural residents earn on average $7,417 less than urban residents 24% rural children live in poverty 20% of US population lives in rural areas, but 10% of physicians are based there Increased burden of heart disease, stroke, diabetes, mental health disorders, tobacco usage and substance abuse
• Literacy? Racial/ Ethnic • Poverty? • Mental health? Women/ Children • Obesity? • Adolescent suicide? GLBT • Unique health care needs? • Reduce burden of disease? Rural Health • Cost/access issues?
Uninsured Tend to be younger (Medicare) More likely to be racial/ethnic minority Estimated ER uncompensated care cost of $31 billion in 2009 Low access to care Homeless 1% of U.S. is homeless each year 40% of homeless men are veterans 26% of homeless have severe mental illness, but only 5- 7% require institutionalization High rates of mental health, acute/chronic medical, substance abuse, assault/victimization, effects of weather
MIGRANT STATUS CORRECTIONAL STATUS While in correctional Continuity of care difficult system, care received can Exposure to harsh be compromised environments After leaving system, (immigration health issues, occupational occupational issues) discrimination Possible language barrier Mental health/substance Often uninsured abuse issues prevalent Undocumented leads to Intersects with homeless fear of accessing health and uninsured enabling characteristics care
• ER visits? Un- • Access and cost? insured • Mental health? Home- • Ascend from less homelessness? • Continuity of care? Mi- grant • Protection if undocumented? • Continuity of care? Correct- • Mental health/ ional substance/ privacy?
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