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primary prevention
- prevent disease before it happens
- vaccination, being healthy
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secondary prevention
- catch disease while still asymptomatic
- screening
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tertiary prevention
- treatment to reduce complications of disease
- chemotherapy, managing diabetes well etc
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quaternary prevention
identifying patients at risk of unnecessary treatment and protecting them from the harm of unnecessary interventions
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medicare (what is it?)
- pure federal
- for the over 65, end stage renal disease, certain disabilities
- medicarE for Elderly, Esrd, Effed up
- 4 parts
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4 parts of medica... fill in the rest
- medicare!
- A - hospital insurance
- B - out patient
- C - A and B delivered by approved private companies
- D - drugs
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medicaid
- joint federal and state
- very low income (133% of FPL)
- financial AID = medicAID
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3 causes of death under 1 year
- congenital malformations
- preterm birth
- SIDS
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3 causes of death 1-14 yo
- unintentional injury
- cancer
- congenital malformations
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3 causes of death 15-34 yo
- unintentional injury
- suicide
- homicide
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3 causes of death 35-44 yo
- unintentional injury
- cancer
- heart disease
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3 causes of death 45-64 yo
- cancer
- heart disease
- unintentional injury
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3 causes of death 65 and over
- heart disease
- cancer
- chronic respiratory disease
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safety culture
- organizational environment in which you can bring up safety concerns without fear of censure to facilitate error idnetification
- event reporting systems for internal and external monitoring
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human factors design
forcing functions, standardization, simplification, guidelines, checklists, consolidating EMRs
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forcing functions
designing things so that you can't mix them up, like making it so IV lines can't connect to NG tubes by having different connectors
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PDSA
- plan, do, study, act
- plan - define problem and solution
- do - test process
- study - measure and analyze
- act - integrate new process into regular workflow
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structural measurements
- type of quality measurement
- capacities of a center, staff, technology, facilities
- can they measure HbA1c
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outcome measurements
- type of quality measurement
- looking at outcomes in patients
- avg HbA1c
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process measurements
- type of quality measurement
- looking at performance within the system
- how many HbA1c's were checked last month
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balancing measurements
- type of quality measurement
- making sure changes in one part of system don't affect other systems
- does lowering HbA1c's cause more hypoglycemia?
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swiss cheese model
looks at how multiple processes were aligned to allow the problem to happen, and reduces focus on one person's error
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active error
something went wrong
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latent error
- an accident waiting to happen
- using different types of IV pumps in the same hospital
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root cause analysis
- identifies all of the problems that led to an error
- use Ishikawa or cause and effect diagram
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failure mode and effects analysis
- what could go wrong and how bad would it be?
- looks at all of the ways a process might fail and prioritizes the by probability of occurence and impact on patients
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