ENVIROMENTAL SCIENCE- CASE STUDY

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ENVIROMENTAL SCIENCE- CASE STUDY

ENVIROMENTAL SCIENCE- CASE STUDY

Bioaccumulation in Aquatic Ecosystems

Part II

1. What is in some fish and shellfish that has caused the EPA and FDA to issue the restriction?

2. Why is there a restriction for pregnant women and young children, but not the rest of the population?

3. Do pregnant women have to avoid all fish? Explain your answer.

4. Should Amanda have avoided the pan-seared tuna for lunch?

Part III

1. What human actions lead to increased mercury levels in the environment?

2. How does the mercury end up in fish? Draw a flow chart following the mercury path.

3. Where in the United States are mercury wet deposition levels highest? What do you think explains this pattern?

4. The EPA criterion for human health is 0.3 ug/g. Which fish species have average mercury concentrations that exceed the EPA limits?

5. The concern level for piscivorous (fish-eating) mammals is 0.1 Hg ug/g. Which fish species have average mercury concentrations that exceed this limit? Why is the mercury level for piscivorous mammals lower than the level for human health?

6. Should you be concerned about mercury toxicity if you catch and eat a largemouth bass in a local lake? Why or why not?

7. In which samples were mercury concentrations the highest (fi sh, streams, or sediment)? Why do you think this is?

Part IV

1. Draw a food web for Lake Washington using the species and food preferences given in Table 3. Start with phytoplankton (algae) as the base of your web and then build up the food chain.

2. Label the species in your food chain as either high (>100 ug/kg), medium (20-100 ug/kg), or low (below20 ug/kg) mercury concentrations. Which types of animals have the highest levels of mercury? Which types of animals have the lowest? Why do you think this is?

Final Activity

1. Imagine you are Tara. Write an email to your friend Amanda explaining what you have learned about mercury. Be sure to convey the aspects of your learning that will be most useful to Amanda.

2. Find two other examples of compounds that biomagnify. Explain how each compound and/or toxin enters the biosphere and what impacts it has on living organisms in general and humans in particular.

3. Distinguish between bioaccumulation and biomagnifi cation and design a mnemonic device for the distinction.

 
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Data Integrity and Ethics

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Data Integrity and Ethics

(Data Integrity and Ethics)

Part 1: Mastrian: Chapters 2, 5, 8, 11, 17, and 19

Question 1
Data are dirty when there are errors such as:

  • Duplicate entries

  • Incomplete or outdated records

  • Both duplicate entries and incomplete or outdated records

  • None of these are correct.

Question 2
Reliable information comes from:

  • Reliable or clean data

  • Authoritative sources

  • Credible sources

  • All of these are correct.

Question 3
The awareness and understanding of a net of information and ways that information can be made useful to support a specific task or to arrive at a decision is called:

  • Acquisition

  • Dissemination

  • Knowledge

  • Information

Question 4
Which statement best reflects the definition of information?

  • It can be used for a variety of purposes.

  • No errors exist in the data or information.

  • It is whole, complete, correct, and consistent data.

  • It is processed data that have meaning.

Question 5
When processing data into information, it is important that the data:

  • Have integrity and quality

  • Reflect human inconsistencies

  • Contain raw facts

  • Contain duplicate facts

Question 6
What do organizational BYOD (Bring Your Own Device) policies typically include?

  • The device must be issued by the organization.

  • The device is subject to routine audits.

  • Both the device must be issued by the organization and the device is subject to routine audits.

  • None of these are correct. Outside devices are forbidden according to HIPAA.

Question 7
The intent of HIPAA was to:

  • Curtail healthcare fraud and abuse and enforce standards for health information

  • Guarantee the security and privacy of health information

  • Assure health insurance portability for employed persons

  • All of these are correct.

Question 8
Which social conventions about right and wrong human conduct are so widely shared that they form a stable general agreement?

  • Ethics

  • Confidentiality

  • Values

  • Morals

Question 9
New technologies in digital communications, electronic health records, and telehealth raise issues related to:

  • Comprehensiveness of care

  • The digital divide

  • Justice and fidelity

  • Privacy and confidentiality

Question 10(Data Integrity and Ethics)
Which principle of ethics has a nursing educator violated in failing to correctly teach his/her students how to calculate medication dosages?

  • Autonomy

  • Confidentiality

  • Justice

  • Nonmaleficence

Question 11
In the design of human technology interface, what best describes the factor(s) to consider?

  • Task and cost

  • Medical opinion

  • Nursing opinion

  • User proficiency

Question 12
The users see the effects of their actions on the technology when you bridge the:

  • Gulf of execution

  • Gulf of understanding

  • Gulf of evaluation

  • Gulf of assessment

Question 13
Videoconferencing technology:

  • Is easy to use

  • Allows professionals to communicate more effectively and frequently with in-home patients

  • Must be used for telehealth

  • None of these are correct.

Question 14
Task analysis examines:

  • The number of tasks involved

  • How the user approaches the task in order to accomplish it

  • What the needed output is

  • All of these are correct.

Question 15
A cognitive walkthrough:

  • Observes the steps users take to use the interface to accomplish typical tasks

  • Detects problems early in the design process

  • Is the least expensive method

  • All of these are correct.

Question 16
Online communication among healthcare teams is called:

  • Order entry management

  • Electronic communication and connectivity

  • Clinical decision making

  • Reporting and population health management

Question 17
Patient data in an electronic health record (EHR) includes demographics, medical and nursing diagnoses, and:

  • Medication lists

  • Allergies

  • Test results

  • All of these are correct.

Question 18
Positive impacts noted with using an informatics system to manage patients with chronic illness include:

  • Guidelines adherence

  • A decrease in emergency department visits

  • Improved provider documentation

  • All of these are correct.

Question 19
The benefits of EHR use recognized in early studies include all of these, except:

  • Increased delivery of guidelines-based care

  • Enhanced capacity to perform surveillance and monitoring for disease conditions

  • Reduction in medication errors

  • Improved workflow

Question 20(Data Integrity and Ethics)
Organizations with the authority to accredit EHRs:

  • Test EHRs

  • Compare EHRs against NIST standards

  • Develop and test EHRs

  • Both test EHRs and compare EHRs against NIST standards

Question 21
What is not a goal of evidence based practice?

  • Improve professional satisfaction

  • Decrease practice variability

  • Increase patient safety

  • Eliminate unnecessary cost

Question 22
What is an important factor to assess when determining if it is possible to implement a study?

  • Contextual meaning

  • Number of people in the study

  • Available technology

  • Established guidelines

Question 23
Context of care evidence may be gathered from:

  • Audit and performance data

  • The culture of the organization

  • Local or national policy

  • All of these are correct.

Question 24
Sources of evidence for practice include:

  • Synthesis of knowledge from research

  • Retrospective or concurrent chart reviews

  • Clinical expertise

  • All of these are correct.

Question 25
What indicates that a healthcare professional recognizes the value of providing evidence-based care?

  • Provides the same care as always

  • Includes research as part of current practice

  • Is offended when patient asks about a new treatment

  • Fails to effectively evaluate sources of information

Question 26
Which statement best describes caring as defined by Watson’s Theory of Human Caring?

  • Caring is cognitive energy focused on changing data into knowledge in a patient encounter.

  • Caring is conscious awareness of one’s strengths and limitations in a patient encounter.

  • Caring is healing consciousness and intentionality to care and promote healing.

  • Caring is the focus of the energy on efficient completion of assessment and diagnosis in a patient encounter.

Question 27(Data Integrity and Ethics)
Patient-centered care means that practitioners should focus on:

  • The subjective experience of patients

  • Data gathered by technology

  • Objective signs and symptoms

  • Their interpretation of the patient’s experience

Question 28
When professionals observe their work for a different perspective and generate insights about how healthcare services and processes could be improved, they are practicing:

  • Centering

  • Bracketing

  • Reflection

  • All of these are correct

Question 29
Clearing the mind of preconceived notions and expectations based on a patient’s diagnosis is known as:

  • Centered caring

  • Bracketing

  • Active listening

  • Healing consciousness

Question 30
Anne has a very busy personal life and is worried about her parents who live 100 miles away and are in failing health. She works as a physical therapist in a rehabilitation unit in a metropolitan hospital.She is the primary therapist for six patients today, one more than the ideal staffing pattern of five. Before entering the room of a particularly anxious patient, Anne takes a few moments to breathe deeply, clear her mind, and review the patient’s EHR on her tablet. She carries the tablet into the room and sets it aside. She moves toward the patient and smiles, making eye contact, and greeting the patient by name. She sits at the bedside and chats with the patient for a brief moment and then performs her assessment. Anne is practicing:

  • Transcendent presence
  • Physical presence
  • Carative presence
  • Cognitive presence
 
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Health Insurance Models Comparison

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Health Insurance Models Comparison

(Health Insurance Models Comparison)

Health Insurance Matriz

Health Insurance Matrix

HCS/235 Version 7

 1

Health Insurance Models Comparison

Health Insurance Matrix

As you learn about health care delivery in the United States, it is necessary to understand the various models of health insurance to develop important foundational knowledge as you progress through the course and for your role as a future health care worker. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers. Fill in the following matrix. Each box must contain responses between 50 and 100 words and use complete sentences.

(Health Insurance Models Comparison)

Model Describe the model How is the care paid or financed when this model is used? What is the structure behind this model? Is it a gatekeeper, open-access, or combination of both? What are the benefits for providers in using this model? What are the challenges for providers in using this model?
Health Maintenance Organization (HMO) . A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.

 

 Health maintenance organizations represent “pre-paid” or “capitated” insurance plans in which individuals or their employers pay a fixed monthly fee for services instead of a separate charge for each visit or service. The monthly fees remain the same, regardless of types or levels of services provided. Services are provided by physicians who are employed by, or under contract with, the HMO. You’ll select a Primary Care Physician who will be the first point of contact for your healthcare. You are encouraged to build a strong relationship with your PCP because they will connect you to specialists or other health care providers. Your PCP will be able to see the total picture of your overall health. With an HMO plan, your out-of-pocket medical costs and monthly premiums will generally be lower than with other types of plans. If you are someone who doesn’t see a lot of specialists or would like having your care coordinated through a PCP, then you might save more money with an HMO plan. Tight controls can make it more difficult to get specialized care

As an HMO member, you must choose a primary care physician (PCP). Your PCP provides your general medical care and must be consulted before you seek care from another physician or specialist. This screening process helps to reduce costs both for the HMO and for HMO members, but it can also lead to complications if your PCP doesn’t provide the referral you need
Preferred Provider Model . A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network . You pay more if you use doctors, hospitals, and providers outside of the network Rather than prepaying for medical care, PPO members pay for services as they are rendered. The PPO sponsor (employer or insurance company) generally reimburses the member for the cost of the treatment, less any co-payment percentage. In some cases, the physician may submit the bill directly to the insurance company for payment. The insurer then pays the covered amount directly to the healthcare provider, and the member pays his or her co-payment amount. The price for each type of service is negotiated in advance by the healthcare providers and the PPO sponsor(s). Free choice of healthcare provider

PPO members are not required to seek care from PPO physicians. However, there is generally strong financial incentive to do so. For example, members may receive 90% reimbursement for care obtained from network physicians but only 60% for non-network treatment. In order to avoid paying an additional 30% out of their own pockets, most PPO members choose to receive their healthcare within the PPO network.

 Out-of-pocket costs generally limited

Healthcare costs paid out of your own pocket (e.g., deductibles and co-payments) are limited. Typically, out-of-pocket costs for network care are limited to $1,200 for individuals and $2,100 for families. Out-of-pocket costs for non-network treatment are typically capped at $2,000 for individuals and $3,500 for families. And they have a free choice of healthcare provider.

 More paperwork and expenses than HMOs

As a PPO member, you may have to fill out paperwork in order to be reimbursed for your medical treatment. Additionally, most PPOs have larger co-payment amounts than HMOs, and you may be required to meet a deductible. Less coverage for treatment provided by non-PPO physicians

As mentioned previously, there is a strong financial incentive to use PPO network physicians.
Point-of-Service Model A Point of Service (POS) plan is a type of managed healthcare system that combines characteristics of the HMO and the PPO. Like an HMO, you pay no deductible and usually only a minimal co-payment when you use a healthcare provider within your network. You also must choose a primary care physician who is responsible for all referrals within the POS network. If you choose to go outside the network for healthcare, POS coverage functions more like a PPO. No “gatekeeper” for non-network care

If you choose to go outside the POS network for treatment, you are free to see any doctor or specialist you choose without first consulting your primary care physician (PCP). Of course, you will pay substantially more out-of-pocket charges for non-network care.

 POS coverage allows you to maximize your freedom of choice. Like a PPO, you can mix the types of care you receive. There is no minimal co-payment. Also when you choose to use network providers, there is generally no deductible. As well as no healthcare cost paid out of your own pocket Substantial co-payment for non-network care

As in a PPO, there is generally strong financial incentive to use POS network physicians. For example, your co-payment may be only $10 for care obtained from network physicians, but you could be responsible for up to 40% of the cost of treatment provided by non-network doctors. Thus, if your longtime family doctor is outside of the POS network, you may choose to continue seeing her, but it will cost you more.
Provider Sponsored Organization A Provider-Sponsored Organization (PSO) is a type of managed care plan that is operated by a group of doctors and hospitals that form a network of providers within which you must stay to receive coverage for your care. People with Medicare can choose to get their Medicare benefits through a PSO. PSO receives a fixed monthly payment to provide care for Medicare beneficiaries. PSOs may be developed as for-profit or not-for-profit entities of which at least 51 percent must be owned and governed by health care providers (physicians, hospitals or allied health professionals). PSOs may be organized as either public or private entities The gatekeeper would be Medicare in the United States can be defined as ‘ A group of doctors, hospitals, and other health care providers that agree to give health care to Medicare beneficiaries for a set amount of money from Medicare every month. This type of managed care plan is run by the doctors and providers themselves, and not by an insurance company
High Deductible Health Plans and Savings Options A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit. You have the freedom to see any health care provider, including specialists, without a referral, although you will save money if you see in-network providers. This is especially important since instead of a copay, you will be paying the full cost of a doctor’s visit or service until you satisfy your deductible Others can contribute to your HSA. Contributions can come from various sources, including you, your employer, a relative and anyone else who wants to add to your HSA. High deductible plans also allow you to meet health plan stipulations that your community may have. By having yourself and your family covered with health insurance, you can be in compliance with specific laws that require insurance coverage. You have high deductible requirement. Even though you are paying less in premiums each month, it can be difficult – even with money in an HSA – to come up with the cash to meet a high deductible.

You have unexpected healthcare costs. Your healthcare costs could exceed what you had planned for, and you may not have enough money saved in your HSA to cover expenses.

 
 
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Interprofessional Staff Update On HIPAA

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Interprofessional Staff Update On HIPAA

(Interprofessional Staff Update On HIPAA)

Social Media Use In Health Care

Prepare A 2-Page Interprofessional Staff Update On HIPAA And Appropriate Social Media Use In Health Care

Introduction

Health professionals today are increasingly accountable for the use of protected health information (PHI). Various government and regulatory agencies promote and support privacy and security through a variety of activities. Examples include:

  • Meaningful use of electronic health records (EHR).
  • Provision of EHR incentive programs through Medicare and Medicaid.
  • Enforcement of the Health Insurance Portability and Accountability Act (HIPAA) rules.
  • Release of educational resources and tools to help providers and hospitals address privacy, security, and confidentiality risks in their practices.

Technological advances, such as the use of social media platforms and applications for patient progress tracking and communication, have provided more access to health information and improved communication between care providers and patients.

At the same time, advances such as these have resulted in more risk for protecting PHI. Nurses typically receive annual training on protecting patient information in their everyday practice. This training usually emphasizes privacy, security, and confidentiality best practices such as:

  • Keeping passwords secure.
  • Logging out of public computers.
  • Sharing patient information only with those directly providing care or who have been granted permission to receive this information.

Today, one of the major risks associated with privacy and confidentiality of patient identity and data relates to social media. Many nurses and other health care providers place themselves at risk when they use social media or other electronic communication systems inappropriately. For example, a Texas nurse was recently terminated for posting patient vaccination information on Facebook. In another case, a New York nurse was terminated for posting an insensitive emergency department photo on her Instagram account.

Health care providers today must develop their skills in mitigating risks to their patients and themselves related to patient information. At the same time, they need to be able distinguish between effective and ineffective uses of social media in health care.

This assessment will require you to develop a staff update for the interprofessional team to encourage team members to protect the privacy, confidentiality, and security of patient information.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

  • Competency 1: Describe nurses’ and the interdisciplinary team’s role in informatics with a focus on electronic health information and patient care technology to support decision making.
    • Describe the security, privacy, and confidentially laws related to protecting sensitive electronic health information that govern the interdisciplinary team.
    • Explain the importance of interdisciplinary collaboration to safeguard sensitive electronic health information.
  • Competency 2: Implement evidence-based strategies to effectively manage protected health information.
    • Identify evidence-based approaches to mitigate risks to patients and health care staff related to sensitive electronic health information.
    • Develop a professional, effective staff update that educates interprofessional team members about protecting the security, privacy, and confidentiality of patient data, particularly as it pertains to social media usage.
  • Competency 5: Apply professional, scholarly communication to facilitate use of health information and patient care technologies.
    • Follow APA style and formatting guidelines for citations and references.
    • Create a clear, concise, well-organized, and professional staff update that is generally free from errors in grammar, punctuation, and spelling.

Preparation

(Interprofessional Staff Update On HIPAA)

To successfully prepare to complete this assessment, complete the following:

  • Review the infographics on protecting PHI provided in the resources for this assessment, or find other infographics to review. These infographics serve as examples of how to succinctly summarize evidence-based information.
    • Analyze these infographics, and distill them into five or six principles of what makes them effective. As you design your interprofessional staff update, apply these principles. Note: In a staff update, you will not have all the images and graphics that an infographic might contain. Instead, focus your analysis on what makes the messaging effective.
  • Select from any of the following options, or a combination of options, the focus of your interprofessional staff update:
    • Social media best practices.
    • What not to do: Social media.
    • Social media risks to patient information.
    • Steps to take if a breach occurs.
  • Conduct independent research on the topic you have selected in addition to reviewing the suggested resources for this assessment. This information will serve as the source(s) of the information contained in your interprofessional staff update. Consult the BSN Program Library Research Guide for help in identifying scholarly and/or authoritative sources.

Instructions

(Interprofessional Staff Update On HIPAA)

In this assessment, assume you are a nurse in an acute care, community, school, nursing home, or other health care setting. Before your shift begins, you scroll through Facebook and notice that a coworker has posted a photo of herself and a patient on Facebook. The post states, “I am so happy Jane is feeling better. She is just the best patient I’ve ever had, and I am excited that she is on the road to recovery.”

You have recently completed your annual continuing education requirements at work and realize this is a breach of your organization’s social media policy. Your organization requires employees to immediately report such breaches to the privacy officer to ensure the post is removed immediately and that the nurse responsible receives appropriate corrective action.

You follow appropriate organizational protocols and report the breach to the privacy officer. The privacy officer takes swift action to remove the post. Due to the severity of the breach, the organization terminates the nurse.

Based on this incident’s severity, your organization has established a task force with two main goals:

  • Educate staff on HIPAA and appropriate social media use in health care.
  • Prevent confidentiality, security, and privacy breaches.

The task force has been charged with creating a series of interprofessional staff updates on the following topics:

  • Social media best practices.
  • What not to do: Social media.
  • Social media risks to patient information.
  • Steps to take if a breach occurs.

You are asked to select one of the topics, or a combination of several topics, and create the content for a staff update containing a maximum of two content pages. When distributed to interprofessional team members, the update will consist of one double-sided page.

The task force has asked team members assigned to the topics to include the following content in their updates in addition to content on their selected topic(s):

  • What is protected health information (PHI)?
    • Be sure to include essential HIPAA information.
  • What are privacy, security, and confidentiality?
    • Define and provide examples of privacy, security, and confidentiality concerns related to the use of the technology in health care.
    • Explain the importance of interdisciplinary collaboration to safeguard sensitive electronic health information.
  • What evidence relating to social media usage and PHI do interprofessional team members need to be aware of? For example:
    • How many nurses have been terminated for inappropriate social media usage in the United States?
    • What types of sanctions have health care organizations imposed on interdisciplinary team members who have violated social media policies?
    • What have been the financial penalties assessed against health care organizations for inappropriate social media usage?
    • What evidence-based strategies have health care organizations employed to prevent or reduce confidentiality, privacy, and security breaches, particularly related to social media usage?
Notes
  • Your staff update is limited to two double-spaced content pages. Be selective about the content you choose to include in your update so that you are able to meet the page length requirement. Include need-to-know information. Leave out nice-to-know information.
  • Many times people do not read staff updates, do not read them carefully, or do not read them to the end. Ensure your staff update piques staff members’ interest, highlights key points, and is easy to read. Avoid overcrowding the update with too much content.
  • Also supply a separate reference page that includes 2–3 peer-reviewed and 1–2 non-peer-reviewed resources (for a total of 3–5 resources) to support the staff update content.
Additional Requirements
  • Written communication: Ensure the staff update is free from errors that detract from the overall message.
  • Submission length: Maximum of two double-spaced content pages.
  • Font and font size: Use Times New Roman, 12-point.
  • Citations and references: Provide a separate reference page that includes 2–3 current, peer-reviewed and 1–2 current, non-peer-reviewed in-text citations and references (total of 3–5 resources) that support the staff update’s content. Current mean no older than 5 years.
  • APA format: Be sure your citations and references adhere to APA format. Consult the APA Style and Format page for an APA refresher.
 
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Information Technology and Systems for Healthcare

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HI 300: Information Technology and Systems for Healthcare

Information Technology and Systems for Healthcare

Questions from Unit 2 graded assignments

Reminders about academic writing & plagiarism

Week 4 Assignment Review

Discussion Board Example

Investigate clinical decision support applications and provide a summary of at least two of the applications that you find. Please provide facts about each of the applications and answer the following questions:

What does the application do?

How does the application help the user?

VisualDx is a unique clinical decision support system that delivers diagnostic answers where and when physicians need them.

Scenario: Imagine that you are the Director of Health Information for a large hospital. As Director, you sit on various institution-wide committees which govern the organization’s policies. You have seen issues arise that cause you to propose changes in policies, procedures and operations across the hospital. Therefore, you have decided to create a proposal to the CEO and Board of Directors, which you will develop in collaboration with committee teams.

Unit 4 Assignment Breakdown

Task #1: Evaluate, implement and manage electronic applications/systems for clinical classification and coding.

Select two (2) applications/systems for clinical classification and coding (e.g., encoders, computer assisted coding (CAC), etc.) and

Appraise each vendor in terms of:

capacity to evaluate quality coding practices;

possible implementation considerations/issues; and

systems management challenges and training needs

Provide support for one (1) system that you find as the “best option“

explain why this is the best option.

Task #2: Evaluate the accuracy of diagnostic and procedural coding.

Consider the principles and applications of classification systems (e.g., ICD-10, HCPCS) and medical record auditing used within a clinical documentation improvement (CDI) program. Appraise the value and challenges of a quality CDI program by:

defending the need for ongoing CDI program support; and

critique at least three (3) challenges in the CDI process.

Make connections between auditing, accurate diagnostic and procedural coding with classification systems, and CDI programs

Your executive summary should reflect upon the need for CDI and best practices for ensuring compliance.

Task #3: Advocate information operability and information exchange.

Critique one (1) interoperability issue that is possible within the health information exchange (HIE) (e.g., patient identity matching).

Appraise at least three (3) best practices that address the issue.

Information Technology and Systems for Healthcare

Brainstorming – Task #3

Health Information Exchange

The need to exchange accurate, complete and timely information.

Patient identify matching

Best practices to ensure interoperability (3)

Need for standards and common vocabularies

Tip #1: What is interoperability in healthcare? https://www.himss.org/library/interoperability-standards/what-is-interoperability

Video Tip #2 Video explanation of interoperability https://youtu.be/PaWcU7rqqyA Video Tip #3: Video explanation of interoperability

Tip #4: Interoperability Examples https://www.healthcareitnews.com/news/health-it-interoperability-example

Task #4: Evaluate health information systems and data storage design.

Evaluate at least three (3) health information systems (HIS)

select the best health information system

why, explain with rationale

Evaluate at least three (3) data storage designs (e.g., onsite, cloud)

select the best data storage design for disaster recovery purposes

why, explain with rationale

Brainstorming – Task #4

Health Information Systems (HIS) Examples:

Specific examples: Phillips Intellispace Console, Archimedes IndiGO, and Diagnosis One

Data Storage Design Examples:

Onsite, Hybrid, Cloud, Tape, Disc

Cost, Disaster Recovery, Oversight

Tip #2: Different Types of health information systems www.floppybunny.org/robin/web/virtualclassroom/chap12/s2/systems1.pdf

Tip #4: Disaster Recovery Planning https://www.healthmgttech.com/best-practices-in-healthcare-disaster-recovery-planning.php

Task #5: Manage clinical indices/databases/registries.

Evaluate three (3) managerial challenges (as hospital’s Director of Health Information) related to:

clinical indices, databases, and registries

Recommend three (3) best practices or policies related to:

management of secondary data sources

Brainstorming – Task #5

Understanding the difference b/t primary and secondary data sources.

Maintaining security and confidentiality

Need to ensuring data quality

Need for clinical documentation (CDI) program

Need for interoperability

Need for compliance with laws, regulations, and accreditation standards.

Need for audit processes

Video Tip #1: Video about Patient Registries https://www.youtube.com/watch?v=_3ZPZ0EKVCE

Task #6: Evaluate data from varying sources to create meaningful presentations.

With respect to data warehousing, appraise at least two (2) approaches in data warehouse design that supports:

quality data management from varying sources;

processing/storage of data throughout the warehouse model;

meaningful output into the presentation layer

Summarize your recommendations in the executive summary.

Chapter 4

15

Brainstorming – Task #6

Top-down, Bottom-Up and Hybrid

Cost, data quality, data marts, data mining

Give a summary of the 2 you choose

Tip #1: Data warehouse design approaches

Tip #2: Data warehouse Overview presentation

Unit 4 Assignments

Discussion

Submit Unit 4 Assignment

Quiz

 
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Cultural Diversity In Health& Illness

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Cultural Diversity In Health& Illness

HCA 340 Cultural Diversity In Health & Illness
Healthcare Administration

HCA UNIT 3

1. The nurse is observing a healing ceremony performed by people of the American Indian culture. What is a characteristic of this ceremony?

a. Sound

b. Quiet

c. Herbal teas

d. Hallucinogenic plants

2. A patient of the American Indian culture tells the nurse that the medicine man is consulted when an illness develops. How does a person become a medicine man?

a. Know the interrelationships between people, the earth, and the universe

b. Understand the ways of plants and animals

c. Perform special ceremonies

d. All of the above.

3. What is the difference between the modern physician and the medicine man when determining the cause of an illness?

a. The medicine man looks for the physical cause of the problem

b. The medicine man looks for the spiritual cause of the problem

c. The medicine man studies the patient’s past medical history to determine the cause of the illness

d. The medicine man studies the dietary practices of the person being seen

4. In which American Indian tribe are meditation and herbs used to create a trance to provide the vision of the evil that causes an illness?

a. Hopi

b. Sioux

c. Navajo

d. Cherokee

5. Which Navajo American Indian divination method will women practice to diagnose the cause of a disease?

a. Singing

b. Listening

c. Motion in the hand

d. Stargazing

6. What is the purpose of sand paintings when diagnosing illness in the Navajo American Indian culture?

a. Creates symbolic representations of the client and family

b. Ensures that appropriate payment is made by the family

c. Provides an atmosphere of calm for the medicine man

d. Determines the cause and treatment of the illness

7. The nurse is conducting a medication history with a patient from the Oneida American Indian culture. Which remedies would the nurse include as part of this history?

a. Witch hazel

b. Comfrey

c. Skunk oil

d. All of the above.

8. A patient that is of the American Indian culture is waiting to be seen in a non-Indian Health Service facility. What concern might this patient have about receiving health care through this route?

a. Conflict between his or her perception of the illness and what the physician diagnoses

b. Easier to receive medical care through emergency departments rather than private physicians

c. Receive better health care from mainstream medical services

d. Concern that medical insurance won’t cover all the medical costs

9. Which action would the nurse take when assessing a patient of American Indian culture?

a. Remaining quiet and recognizing the importance of nonverbal communication to seek  information

b. Asking detailed questions regarding the presenting symptoms

c. Asking indirect questions about the reason for seeking health care

d. Ensuring that no one beyond the medical provider and the client discuss what has brought the client to seek care

HCA 340 Cultural Diversity In Health & Illness
10. Which is a concept of holism in traditional Chinese medicine?

a. Integration of the body with the external environment

b. Energy fields that create health or disease

c. Local pathology as separate from the body

d. Harmonic balance that creates illness

11. Which action would a patient, who practices Ayurvedic medicine, take to reestablish harmony and balance in the body?

a. Sit in the sun

b. Speak to a doctor

c. Yoga

d. Ingest a substance to cleanse the body of substances that cause disease

12. The nurse is planning care for a group of community members who follow Ayurveda medicine. What beliefs about this form of health care would the nurse need to keep in mind while  planning this care?

a. All things in the universe are joined together.

b. Human beings contain elements that can be found in the universe.

c. All people are born in a state of balance.

d. All of the above.

13. A patient of the Asian culture tells the nurse that an alteration in yin and yang will lead to disease. Which variable can affect the body’s yin and yang?

a. Clothing

b. The weather

c. Social class

d. Improper food preparation

14. Why does the Chinese physician focus on palpating a patient’s pulse?

a. It is considered the storehouse of the blood.

b. It indicates a specific treatment.

c. It can help to cure a patient.

d. It determines the time of death.

15. A belief of Ayurvedic medicine is the concept of doshas. What is a characteristic of this concept?

a. Combine space and air to control nutritional preferences

b. Blend fire and water to balance mental capacities

c. Are constantly formed and reformed by food, activity, and bodily processes

d. Use water and earth to regulate hormonal balance

HCA 340 Cultural Diversity In Health & Illness
16. While assessing the health history of a patient who is an Asian/Pacific Islander, what will the  nurse identify as a leading cause of death for people from this culture?

a. Malignant neoplasms

b. Influenza and pneumonia

c. Alzheimer’s disease

d. Chronic lower respiratory diseases

17. Why does poor health continue to occur among immigrant Asian populations?

a. Poor working environments and crowded living conditions

b. Refusal of Western medicine to treat Asian immigrants

c. Inability to tolerate Western medications

d. Low number of health care workers of Asian origin

18. How would a patient from the Black culture treat poison ivy?

a. Sprinkling crushed bluestone powder on the affected area

b. Placing a mixture of garlic, onions, and parsley on the site

c. Placing clay in a dark leaf over the affected area

d. Rubbing Vicks Vaporub on the area

19. In the Black culture, what would be used to treat colds?

a. Sassafras tea

b. Hot lemon water with honey

c. Hot toddy made of tea, honey, lemon, peppermint, and alcohol

d. All of the above.

20. Why are folk remedies still used today in the Black community?

 

a. Tradition of quality care and treatment by healers

b. Acknowledgement of the African heritage

c. Rituals associated with folk remedies

d. Close proximity of hospitals in the community

21. What would be a benefit of following the African food tradition of geophagy?

a. Dirt is high in calcium

b. Pica is an accepted cultural practice

c. Red clay is rich in iron

d. Starch is sweet and dry

22. For which reasons might a patient of the Black culture and of the Muslin religion refuse insulin to treat diabetes mellitus?

a. Because any injectable medication is forbidden

b. If it has a pork base

c. Because it implies the person has not led a holy life

d. During Ramadan

HCA 340 Cultural Diversity In Health & Illness
23. Which is a health statistic of significance to Black or African Americans when compared to all races?

a. A lower incidence of breast cancer

b. Lower percentages of low birth weight infants

c. A lower crude birth rate

d. Lower male death rates from homicide

24. Who does the nurse recognize as being the leading authority figure within the Black familial structure?

a. Female

b. Minister

c. Male

d. Oldest adult child

25. Why would some patients of the Black culture resent using health clinics for care?

a. Prescription medications are given out only to those seen first.

b. Cheaper accessible health care is regarded as demeaning.

c. A day’s work may be lost in waiting to be seen by a physician.

d. There are not enough clinics to focus on Black health problems.

 
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Comparison of Hospital Performance

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Comparison of Hospital Performance

(Comparison of Hospital Performance)

Alesix Tieku

Dr. Hossein Zare,

Research and Data Analysis

HMGT 400 (7980)

March 20, 2019

Week 1, Exercise:

The attached dataset, provides some information about hospitals in 2011 and 2012, download the data and then complete the descriptive table. Please use the following format to report your findings.

Table 1. Descriptive statistics between hospitals in 2011 & 2012

Variables 2011 2012 p-value
N Mean St. Dev N Mean St. Dev
Hospital beds 1505 376.6086 560.8998 1525 376.8 579.8366 < 2.2e-16
Number of paid Employee 1498 1237.276 1615.797 1515 1491.121 1961.637 < 2.2e-16
Number of non-paid Employee 30 39.973 72.58805 30 44.76976 81.29861 6.653e-05
Total hospital cost 1505 216873322 304570722 1525 214748023 294143536 < 2.2e-16
Total hospital revenues 1505 228706319 323339811 1525 229978391 321273114 < 2.2e-16
Available Medicare days 1499 16739.16 19214.29 1516 17110.14 19765.74 < 2.2e-16
Available Medicaid days 1484 5301.199 9207.699 1501 5366.333 9340.373 < 2.2e-16
Total Hospital Discharge 1500 9492.326 10898.6 1517 9544.051 10994.17 < 2.2e-16
Medicare discharge 1499 3230.624 3388.957 1516 3598.248 3785.675 < 2.2e-16
Medicaid discharge 1481 1130.727 1757.158 1498 1119.547 1740.423 < 2.2e-16

 

Based on your findings in which years hospitals had better performance? Please write a short paragraph and describe your findings.

The hospitals had better performance in 2012 compared to 2011. The mean number of hospital beds in 2012 was slightly higher than the mean number of hospital beds in 2011. In terms of revenue, the mean revenue in 2012 was higher than the mean revenue in 2011. The total cost in 2011 was also higher than the total cost in 2012. For these variables, the p. Value is less than 0.05 hence the null hypothesis is not rejected at 95% confidence interval. This implies that the means between the two groups are not different.

solution 

Comparison of Hospital Performance: 2011 vs. 2012

Based on the descriptive statistics provided in the dataset, hospitals performed slightly better in 2012 than in 2011. The mean number of hospital beds in 2012 (376.8) was marginally higher than in 2011 (376.6), suggesting that hospitals maintained or slightly increased their capacity. Additionally, the mean number of paid employees rose notably from 1,237 in 2011 to 1,491 in 2012, reflecting an increase in staffing, which could contribute to improved care delivery and operational efficiency.

Moreover, total hospital revenues increased slightly in 2012, rising from an average of $228.7 million to $229.9 million, while total hospital costs slightly decreased from $216.9 million to $214.7 million. This favorable shift in financial indicators suggests improved cost management and potentially higher profitability. Available Medicare and Medicaid days also increased, along with the number of discharges, indicating higher patient throughput and greater service utilization.

Despite all p-values being less than 0.05—specifically noted as less than 2.2e-16—this statistical significance does not necessarily imply a large or meaningful practical difference. Rather, it shows that the observed differences in means between 2011 and 2012 are statistically significant due to the large sample size. Therefore, even slight changes can appear statistically significant.

In conclusion, the descriptive data suggest slightly improved hospital performance in 2012, characterized by increased revenue, more paid staff, and higher service output, despite minimal differences in some variables.

 
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Cultural Diversity in Health & Illness

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HCA 340 Cultural Diversity in Health & Illness

(Cultural Diversity in Health & Illness)

Multiple Choice Questions (Enter your answers on the enclosed answer sheet)

1. A patient from the Mexican heritage relates using a curandero for health care needs. What are the characteristics of this type of healer?

a. Considered to be a religious figure

b. Was born as a healer

c. Taught the ways of healing through herbs

d. All of the above.

2. In the Mexican health care system, what is the scope of practice of the partera?

a. The care given is confined to the pregnant woman

b. Only provides physical care

c. Acts alone without doing other consultations or referrals

d. Does not participate in labor and delivery

3. During a medical history with a patient from Puerto Rico, what preparations will the nurse need to include?

a. Those obtained from a botanica

b. Those obtained from a botanical center

c. Those obtained from a healer

d. Those obtained from a pharmacy

4. Which is a dilemma encountered by health care providers when trying to accommodate a patient of the Mexican culture’s desire to maintain hot and cold food preferences?

a. Avoiding all foods that contain certain spices

b. Understanding which foods the patient considers hot and cold

c. Obtaining the unusual foods native to a Mexican patient’s diet

d. Ensuring that all medications are taken with specific foods

5. Where might a patient of Puerto Rican heritage seek help when experiencing signs of a mental illness?

a. Milagros

b. Curanderismo

c. Santeria

d. Partera

6. What is a significant factor when caring for health problems of patients within the Hispanic culture?

a. Lack of Spanish-speaking health care providers impeding appropriate care delivery

b. Failure to highlight common chronic diseases among Hispanics in local media

c. Overall population is elderly

d. Use of folk remedies creating cultural dissonance with the medical establishment

7. What would the combination of a young population, high birthrates, and lower socioeconomic status contribute to in the Hispanic population?

a. Higher incidence of births to women under age 18

b. Lower birth weight infants

c. Higher percentage of first trimester prenatal care

d. Higher infant mortality rate

8. Which health problem does the nurse identify as being a higher risk for the patient from the Hispanic culture when compared to the general population?

a. Septicemia

b. Unintentional injuries

c. Chronic lower respiratory diseases

d. Alzheimer’s disease

9. What would the nurse infer about the incidence of lung cancer being lower among Hispanic women versus that of the general population?

a. Hispanic women are not genetically predisposed to lung cancer.

b. Hispanic women are healthier than the general population.

c. Hispanic women have better preventive health practices.

d. Hispanic women are less likely to smoke.

10. What might a patient of German descent used to treat a stomachache?

a. Drink peppermint tea

b. Stop eating for at least 24 hours

c. Take black draught

d. Eat chicken soup

11. Which actions might a patient of German descent use to treat a cough?

a. Rub goose fat on the chest

b. Eating honey and milk

c. Drinking rum

d. All of the above.

12. When caring for a postoperative wound at home, what would a patient of German descent tend to use?

a. Kerosene

b. Iodine

c. Salves and liniments

d. Onion compresses

13. For what would a patient of German descent use cloves?

a. Headache

b. Rheumatism

c. Toothache

d. Fever

14. What would a patient of Italian descent tell the nurse is the cause of pneumonia?

a. Moving air in the form of drafts

b. Eating food that was not nutritious

c. Improper balance of fluids

d. Not dressing properly

Cultural Diversity in Health & Illness

15. What will the nurse assess as an important component of healing for a patient of Italian descent?

a. Religious faith in God

b. Use of garlic and olive oil in tonics

c. Wearing black when a family member is ill

d. Eating pasta at every meal

16. What will a patient of Polish descent tell the nurse is used to treat a cough?

a. Taking garlic oil

b. Goose grease rubbed on the throat

c. Drinking hot lemonade with whiskey

d. A tomato plaster on the chest

17. What will a patient of Polish descent use to treat a burn?

a. Aloe vera

b. Salt pork

c. Carbolic salve

d. Turpentine and liniment

18. For what would a patient of Polish descent tell the nurse that paregoric is used?

a. Gas

b. Diarrhea

c. Indigestion

d. Cramps

19. In which ways does the current United States health care system create barriers to individuals from different cultures?

a. Expectation to select a physician from a list

b. Cost of treatments and tests

c. Violation of cultural beliefs and practices

d. All of the above.

20. How would the use of patient advocates bridge the gap of inadequate numbers of health care providers representing culturally diverse population groups?

a. Speak to patients in their native language

b. Coordinate services to meet the patients’ needs

c. Resolve problems

d. All of the above.

21. The health care administrator is identifying ways to improve communication with non-English speaking patients. Which languages would the administrator target as being spoken by hospital employees?

a. Russian

b. Chinese

c. Spanish

d. None of the above.

22. The nurse is experiencing collisions when attempting to improve cultural competency. What types of collisions is this nurse experiencing?

a. Meeting dense cultural barriers

b. Sabotaged efforts

c. Unexpected hills

d. a and b only

23. Two nurses are overhead talking about their experiences with cultural competency. Which experience would be considered an unexpected positive event?

a. Deep love of life and people

b. Role of a healer within a culture

c. Learning a foreign language

d. Being an advocate for funding

24. What self-observation does the nurse make that indicates that the nurse is “on the road” to cultural competency?

a. you should only observe your own health and illness beliefs

b. Individual culture and religion

c. Adhering to ways to protect health that are consistent with the dominant culture

d. Avoiding the use of amulets

 

25. What action would a nurse take to learn more about the different cultures represented in the community?

a. Walk through the community

b. Prepare a guide sheet with a list of herbs

c. Recognize hot–cold imbalances

d. Recognize folk diseases

 
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Human Nutrition Assignment

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Human Nutrition Assignment

(Human Nutrition Assignment)

Assignment 1: Assessing Reliable Sources

The goal of this assignment is to introduce you to methods used to determine reliable sources of nutrition information. It is important to know how to evaluate health-related information and turn to reliable sources and experts when in need of specific advice. Be sure to read the Health Connection 1 section at the end of Chapter 1 – “How can you find and recognize credible nutrition information?” (p.28-30). Review the first three websites in the  Resources for Chapters 1 & 2  for more detail. You can use the “W” questions from these guides or questions from the book.

Part 1

— Find three websites that  provide information related to nutrition AND health . At least two of these websites should be “.com”  Make sure these websites provide information  to the public . — Analyze each website and determine whether it is a reliable source of information by answering the “W” questions.   — Assign each website a rating of 1-10 for reliability, where 10 is the highest. Remember that you are not assessing whether you like the website or not. Your goal is to assess the  reliability of the information the site provides.   — Write the following for each website:

· Name of the website and its web address (URL)

· A  brief  description of the site and the kind of information it provides

· Your  detailed analysis of reliability , using the “W” questions

· The grade you gave it and the  reasons  for assigning this grade

Part 2

— Find two nutrition experts or individuals who give advice in nutrition in the media. You can use the names from your research of websites in Part 1.   — Write the following for each expert:

· Name of the person and where you found him/her. Provide a reference.

· How did you come across this expert? Why did you decide to choose them?

· Include their academic degrees, professional credentials, professional accomplishments, and their current job position.

· Based on the information in Health Connection 1, do you consider them to be a reliable nutrition expert? Why or why not? Explain. You need to  justify  your opinion.

Use a question-and-answer format for each website. Indicate what exactly questions you are answering.  Provide a reference to the source of the questions you are using (even if it is the textbook).

Your submission will be assigned for anonymous peer review. Please DO NOT write your name on the document. 

Review  Guidelines for Assignments   and the rubric (below) to see how you will be graded for this assignment.

Follow this Rubric

Assessing Reliable Sources-1(Human Nutrition Assignment)

Criteria Ratings Pts

This criterion is linked to a Learning Outcome 1. Provides thorough review of THREE nutrition-related websites. The choice of websites is appropriate. Assesses reliability of websites using the “W” questions, and assigns a rating of 1-10. Evaluation is justified. URL is provided for each website. Well organized, uses original and critical thought.

30.0 pts

This criterion is linked to a Learning Outcome 2. Provides thorough review of credentials for TWO nutrition experts. Appropriately assesses credibility of nutrition experts using criteria from Health Connection 1. Reference for each expert is provided. Well organized, uses original and critical thought.

10.0 pts

This criterion is linked to a Learning Outcome 3. Uses appropriate English grammar, sentence structure, with no errors in spelling, punctuation, and capitalization. Assignment is properly formatted – title, Reference List, paragraph structure, appropriate font, etc.

4.0 pts

This criterion is linked to a Learning Outcome 4. Reviews 2 submissions by other students, fills out the rubric, writes thoughtful feedback. Comments are well organized, critical thought is used. Uses appropriate English grammar. 3 points for each review.

6.0 pts

Total Points: 50.0

Assignment 1: Assessing Reliable Sources

(Human Nutrition Assignment)

The goal of this assignment is to introduce you to methods used to determine reliable sources of nutrition information. It is important to know how to evaluate health-related information and turn to reliable sources and experts when in need of specific advice.

Be sure to read the Health Connection 1 section at the end of Chapter 1 “How can you find and recognize credible nutrition information?” (p.28-30). Review the first three websites in the Resources for Chapters 1 & 2 for more detail. You can use the “W” questions from these guides or questions from the book.

Part 1

Find three websites that provide information related to nutrition AND health. At least two of these websites should be “.com.” Make sure these websites provide information to the public.

Analyze each website and determine whether it is a reliable source of information by answering the “W” questions.

Assign each website a rating of 1-10 for reliability, where 10 is the highest. Remember that you are not assessing whether you like the website or not. Your goal is to assess the reliability of the information the site provides.

Write the following for each website:

  • Name of the website and its web address (URL)

  • A brief description of the site and the kind of information it provides

  • Your detailed analysis of reliability, using the “W” questions

  • The grade you gave it and the reasons for assigning this grade

Part 2

Find two nutrition experts or individuals who give advice in nutrition in the media. You can use the names from your research of websites in Part 1.

Write the following for each expert:

  • Name of the person and where you found him/her. Provide a reference.

  • How did you come across this expert? Why did you decide to choose them?

  • Include their academic degrees, professional credentials, professional accomplishments, and their current job position.

  • Based on the information in Health Connection 1, do you consider them to be a reliable nutrition expert? Why or why not? Explain. You need to justify your opinion.

Use a question-and-answer format for each website. Indicate what exactly questions you are answering. Provide a reference to the source of the questions you are using (even if it is the textbook).

 
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Smoking and Lung Cancer Epidemiology

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Smoking and Lung Cancer Epidemiology

(Smoking and Lung Cancer Epidemiology)

Epidemiology Worksheet

IHP 330 Module Two Worksheet Measuring Disease

A causal relationship between cigarette smoking and lung cancer was first suspected in the 1920s on the basis of clinical observations. To test this apparent association, numerous epidemiologic studies were undertaken between 1930 and 1960. Two studies were conducted by Richard Doll and Austin Bradford Hill in Great Britain. The first was a case-control study begun in 1947 comparing the smoking habits of lung cancer patients with the smoking habits of other patients. The second was a cohort study begun in 1951 recording causes of death among British physicians in relation to smoking habits. This case study deals first with the case-control study, then with the cohort study.

Data for the case-control study were obtained from hospitalized patients in London and vicinity over a four-year period (April 1948 – February 1952). Initially, 20 hospitals, and later more, were asked to notify the investigators of all patients admitted with a new diagnosis of lung cancer. These patients were then interviewed concerning smoking habits, as were controls selected from patients with other disorders (primarily nonmalignant) who were hospitalized in the same hospitals at the same time. Data for the cohort study were obtained from the population of all physicians listed in the British Medical Register who resided in England and Wales as of October 1951. Information about present and past smoking habits was obtained by questionnaire. Information about lung cancer came from death certificates and other mortality data recorded during ensuing years.

Over 1700 patients with lung cancer, all under age 75 were eligible for the case-control study. About 15% of these persons were not interviewed because of death, discharge, severity of illness, or inability to speak English. An additional group of patients were interviewed by later excluded when initial lung cancer diagnosed proved mistaken. The final study group included 1,465 cases (1,357 males and 108 females). The following table shows the relationship between cigarette smoking and lung cancer among male cases and controls:

Table 1

Cases Controls
Cigarette Smoker 1,350 1,296
Nonsmoker 7 61
Total 1,357 1,357

 

1. Accurately calculate the proportion of cases that smoked. Be sure to show your calculations.

2. Accurately calculate the proportion of controls that smoked. Be sure to show your calculations.

3. Accurately calculate the odds ratio, with the correct equation. What do you infer from the odds ratio about the relationship between smoking and lung cancer?

Table 2 shows the frequency distribution of male cases and controls by average number of cigarettes smoked per day.

Table 2: Daily cigarette consumption(Smoking and Lung Cancer Epidemiology)

Daily Number of Cigarettes Number of Cases Number of Controls Odds Ratio
0 7 61 Referent
1–14 565 706
15–24 445 408
25+ 340 182
All smokers 1350 1296
Total 1357 1357

4. Accurately calculate the odds ratios by category of daily cigarette consumption, comparing each category to nonsmokers. Be sure to show your calculations.

5. Interpret these results, and describe the trends or patterns you see in the data.

Part 2: The Cohort Study

Data for the cohort study were obtained from the population of all physicians listed in the British Medical Register who resided in England and Wales as of October 1951. Questionnaires were mailed in October 1951 to 59,600 physicians. The questionnaire asked the physicians to classify themselves into one of three categories: 1) current smoker, 2) ex-smoker, or 3) nonsmoker. Smokers and ex-smokers were asked the amount they smoked, their method of smoking, the age they started to smoke, and, if they had stopped smoking, how long it had been since they last smoked. Nonsmokers were defined as persons who had never consistently smoked as much as one cigarette day for as long as one year. Physicians were also asked whether or not they had a diagnosis of lung cancer. Usable responses to the questionnaires were received from 40,637 (68%) physicians, of whom 34,445 were males and 6,192 were females. The next section of this case study is limited to the analysis of male physician respondents, 35 years of age or older.

The occurrence of lung cancer in physicians responding to the questionnaire was documented over a 10-year period (November 1951 through October 1961) from death certificates filed with the Registrar General of the United Kingdom and from lists of physician deaths provided by the British Medical Association. All certificates indicating that the decedent was a physician were abstracted. For each death attributed to lung cancer, medical records were reviewed to confirm the diagnosis.

Diagnoses of lung cancer were based on the best evidence available; about 70% were from biopsy, autopsy, or sputum cytology (combined with bronchoscopy or X-ray evidence); 29% were from cytology, bronchoscopy, or X-ray alone; and only 1% were from just case history, physical examination, or death certificate. In total, there were 355 cases of lung cancer during this 10-year time period, with 255 newly diagnosed cases of lung cancer.

Of 4,597 deaths in the cohort over the 10-year period, 157 were reported to have been caused by lung cancer; in 4 of the 157 cases this diagnosis could not be documented, leaving 153 confirmed deaths from lung cancer.

The following table shows numbers of lung cancer deaths by daily number of cigarettes smoked at the time of the 1951 questionnaire (for male physicians who were nonsmokers and current smokers only). Person-years of observation (“person-years at risk”) are given for each smoking category. The number of cigarettes smoked was available for 136 of the persons who died from lung cancer.Table 3: Number and rate (per 100,000 person-years) of lung cancer deaths by number of cigarettes smoked per day, Doll and Hill physician cohort study, Great Britain, 1951–1961.

(Smoking and Lung Cancer Epidemiology)

Daily number of cigarettes smoked Deaths from lung cancer Person-years at risk Mortality rate per 1,000 person-years
0 3 42,800 0.07
1–14 22 38,600
15–24 54 38,900
25+ 57 25,100
All smokers 133 102,600
Total 136 145,400

6. Accurately calculates the lung cancer mortality rates for each smoking category. Be sure to show your calculations.

7. Describe the trends or patterns you see in the data about mortality, and explain what the trends or patterns mean.

8. Accurately calculate the incidence for lung cancer during the 10 year time period. Be sure to show your calculations.

9. Accurately calculate the prevalence for lung cancer during this 10 year time period. Be sure to show your calculations.

This worksheet was modified using information from the original case study found on the CDC website:

Centers for Disease Control. (2003). “Cigarette smoking and lung cancer.” Centers for Disease Control and Prevention Epidemiology Program Office Case Studies in Applied Epidemiology, 731-703. Retrieved from: https://www.cdc.gov/eis/downloads/xsmoke-student-731-703.pdf

 
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