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Description: Describe AHRQ

Health Science

Description: Describe AHRQ. Describe NICE. Compare and contrast these organizations. Describe their respective roles in the context of cost, access, and quality. Take a position on when, if ever, regulation is beneficial or harmful. Identify who should be responsible for regulation and what powers (enforcement capacity) they should have.

Rationale: This course aims to explore different health care systems to illustrate different approaches and how these differences can produce different outcomes. This assignments directs the exploration of different types of health system’s infrastructure in two countries to illustrate differences with public health implications.



An introduction is provided with a clear description of the assignment, its purpose as it relates to the class, what you will be writing about and how it will be structured in the paper.


Describe AHRQ in detail discussing what the organization does, what their goals are, how they relate to the healthcare system, and how they relate to public health.


Describe NICE in detail discussing what the organization does, what their goals are, how they relate to the healthcare system, and how they relate to public health.


Take a position on when, if ever, regulation is beneficial or harmful. Identify who should be responsible for regulation and what powers (enforcement capacity) they should have.


Conclusion restating central points of the paper, how it relates to public health and to the course.


Clearly written, free of grammatical and spelling errors, and APA formatted

CEPH Competency: 5 Compare the organization, structure and function of health care, public health and regulatory systems across national and international settings

*Please save file: firstname_lastname_Assignment3

Additional Directions: This assignment should not be longer than 3 pages and no less than 2 pages double spaced. Please also provide an APA formatted title page and a references section as appropriate.


PBH 500: Foundations of the United States Healthcare System Week 5: Cost, Access, and Quality and Implications for Public Health Colleen Payton, PhD MPH CPH MCHES Overview of today’s class • • • • Historic developments (1980’s - today) Assignment 3 and writing tips Cost, access, and quality In class assignment Upcoming assignments • Due 5/12 • Upload in class activity to Canvas • Complete Quiz 5 on Canvas • Assignment 3 Current events Prepare a 1 minute overview of a current events topic that relates to US healthcare system for class discussion. • April 15 - Nasser • April 22 - Jacob • April 29 - Anthony • May 6 - Alexa • May 13 - Evan • May 20 - Isabella • May 27 - Gabrielle • June 10 - Matthew • June 17 – Marsha • June 24 – Laiquannah COVID-19 and the US Healthcare System • What are your reflections on how the recent public health circumstances has or will have an effect on the US healthcare system? The 1980’s – Today • Created brief video posted to Canvas Helpful tips for written assignments • • • • • Original thinking – think beyond the material covered in class Be specific and use examples Include a balance of opinion from all stakeholders Take an objective approach - Don’t use the word “should” Not just “what” but “how” Helpful tips for written assignments • High quality and up-to-date references • • • • Peer-review articles Commonwealth Fund and Kaiser Family Foundation Agency for Healthcare Research and Quality (AHRQ) Institute for Healthcare Improvement (IHI) • Start writing early • APA formatting • Google Scholar Assignment 3 Assignment 3 Chapter 12 – Cost, Access, and Quality Why discuss cost, access, and quality? • Metrics to assess the “success” of a healthcare system • All 3 required for a successful system Why cost, access, AND quality? Quick break Cost of healthcare Cost of healthcare • Macro-Level Measures • Comparisons of Medical vs. General inflation • % of GDP or changes in comparison to GDP • National comparisons • Micro-Level Measures • Employers purchasing insurance • Out-of-pocket individual • Provider costs (facilities, supplies, etc.) Cost of healthcare – Trends in national health expenditures Evaluated 3 Ways 1. Medical Inflation to General • Annual changes in the consumer price index (CPI) • *Medical inflation has remained consistently > CPI 2. Comparisons of NHE on healthcare to GDP • Health care spending has consistently surpassed general economy 3. Other nations • Healthcare spending higher than other nations Cost of healthcare – Trends in national health expenditures Cost of healthcare – Trends in national health expenditures Cost of healthcare – Trends in national health expenditures Reasons for cost escalation Reasons for cost escalation 4 primary drivers of high costs 1. 2. 3. 4. Pharmaceuticals Physicians Tests Administrative costs • Planning, regulating and managing Access to care • Ability of a person to obtain health care services when needed • Ability to obtain needed, affordable, convenient, acceptable, and effective personal health services in a timely manner Access to care – Dimensions of care • Accessibility - fit between the locations of providers and patients • Affordability- individuals’ ability to pay • Accommodation- fit between how resources are organized to provide services and the individual’s ability to use the arrangement • Acceptability- compatibility between patients and providers • Patient attitudes about providers’ personal and practice characteristics • Provider attitudes toward their clients’ personal characteristics and values Access to care – Types of access • Potential access- both health care system characteristics and enabling characteristics • Realized access- type, site, and purpose of health services • Equitable access- distribution of health care services according to the patient’s self-perceived need or evaluated need as determined by a health professional • Inequitable access- services distributed according to enabling characteristics • Effective and efficient access- links realized access to health outcomes Patient Protection and Affordable Care Act • Insurance coverage and access to health care have increased • Fewer report problems with medical bills and financial barriers • Preventive services without cost sharing was expanded • Still gaps in access to and affordability of care • Barriers are experienced by vulnerable population groups • Access is best predicted by race, income, and occupation Quality of care • Degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (IOM) Quality of care • According to IOM (2000), 44,000 to 98,000 patients die in U.S. hospitals each year because of medical errors • 2016 study suggested that medical errors are the 3rd leading cause of death in the US • Medication errors (adverse drug events) - errors in prescribing and administering medicines to patients • Surgical errors - errors in performing surgical operations • Diagnostic inaccuracies may lead to incorrect treatment or unnecessary testing • Systemic factors may contribute to preventable adverse events (ex: organization of health care delivery and distribution of resources) The Good Nurse Charles Cullen New Jersey and Pennsylvania Suicide attempts 16 year career as a nurse (1987 – 2003) • Killed patients - Lethal overdose of drugs • • • • Dimensions of Quality Dimensions of quality • Micro view: services at the point of delivery and their effects • Clinical aspects • Interpersonal aspects • Quality of life • Macro view: quality from the standpoint of populations • • • • Life expectancy Mortality rates Incidence and prevalence of certain health conditions Health Inequities Quality assessment • Measurement of quality against an established standard • Process of defining how quality is to be determined • Identification of specific variables or indicators to be measured • Collection of appropriate data to make the measurement possible • Statistical analysis • Interpretation of the results of the assessment Quality assurance or improvement • Process of institutionalizing quality through ongoing assessment and using the results of assessment for continuous quality improvement • Goes a step beyond quality assessment • System-wide or organization-wide commitment to engage in the improvement of quality on an ongoing basis Institute for Healthcare Improvement Processes that improve quality • Clinical practice guidelines • Explicit descriptions representing preferred clinical processes for specified conditions • Cost efficiency • Overutilization vs. Underutilization • Critical pathways • Outcome-based and patient-centered case management tools that are interdisciplinary in nature, facilitating coordination of care among multiple clinical departments and caregivers • Risk management Public reporting of quality • CMS programs on quality • Initiatives to improve care provided to Medicaid and CHIP enrollees • AHRQ quality indicators • Prevention, inpatient, patient safety, and pediatric • States’ public reporting on hospital quality • Hospital outcomes: acquired infections, readmission rates, and mortality rates ACA and the iron triangle • Accessible, Safe, and Patient-centered • Patient-Centered Outcomes Research Institute (PCORI) • Address environmental, social, and behavioral influences on health and health care • Investments in nurses and primary care • Investments in geographic maldistribution • Make care more affordable • Out of pocket maximums • Can not be excluded for pre-existing conditions Quick break In class activity • Identify dimensions of access, quality, and cost • Share your perspectives in groups • Develop a framework for assessing what influences variations in cost, access, and quality • Discuss how structural bias, social inequities and racism undermine health and create challenges to achieving health equity at organizational, community and societal levels Upcoming assignments • Due 5/12 • Upload in class activity to Canvas • Complete Quiz 5 on Canvas • Assignment 3 Acknowledgements • Content from these slides came from: • Delivering Health Care in America, Seventh Edition. Leiyu Shi & Douglas A. Singh Jones & Bartlett Learning; Copyright 2019. ISBN-13: 9781284124491 • Colin Plover, PhD, MSN/MPH, MSN, RN-BC

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