Managerial epidemiology : [concepts and cases]

510 Pages·2008·27.079 MB·English

by  Steven T Fleming

m
Managerial Epidemiology
Concepts and Cases, Second Edition,
provides a comprehensive introduction to epidemiology and explains how to use a
manag erial
epidemiological concepts and tools to improve decision-making in the management of
health services. Throughout the book, basic principles are presented and then expanded
n
upon with healthcare management and public health applications as well as case studies.
This edition features a new approach. Rather than separating epidemiology epidemiology
a
principles from application, it blends theory and application in each chapter.
g
THIS EDITION FEATURES:
e
concepts
• New chapters on infectious-disease epidemiology, morbidity, mortality, descriptive
epidemiology, and cost-effectiveness analysis r
• A pplication chapters that focus on cardiovascular disease, HIV, and Alzheimer’s disease
i
and cases
• More than 40 in-depth case studies of varying levels of difficulty, along with a
questions and detailed answers
• Insight from distinguished experts
l

e
“Managerial epidemiology is as critical to managing healthcare organizations as managerial
accounting....Understanding the health of populations and communities is essential for the p
careful planning and execution of good healthcare decisions....With the tools provided by
i
Managerial Epidemiology, [healthcare leaders] will succeed admirably.” d
—James W. Holsinger Jr., MD, PhD, Charles T. Wethington Endowed Chair in the Health Sciences, e
College of Public Health, and Chancellor-Emeritus, Chandler Medical Center, University of Kentucky
m
(from the foreword)
i Steven T. Fleming
o
Steven T. Fleming, PhD, is an associate professor of epidemiology and health
services management in the College of Public Health at the University of Kentucky.
l
He teaches introductory, advanced, cancer, and managerial epidemiology to nursing
and public health students at the University of Kentucky and health administration o
students in the United Arab Emirates.
g
y
second edition
Order No: 2103
Flemming_Int:FRIED/BOOK 6/18/08 8:55 AM Page i
MA NAG E RI A L
EPI DEMIOLO GY
SECOND EDITION
Flemming_Int:FRIED/BOOK 6/18/08 8:55 AM Page ii
AUPHA
Editorial Board
HAP
Sandra Potthoff, Ph.D., Chair
University of Minnesota
Simone Cummings, Ph.D.
Washington University
Sherril B. Gelmon, Dr.P.H., FACHE
Portland State University
Thomas E. Getzen, Ph.D.
Temple University
Barry Greene, Ph.D.
University of Iowa
Richard S. Kurz, Ph.D.
St. Louis University
Sarah B. Laditka, Ph.D.
University of South Carolina
Tim McBride, Ph.D.
St. Louis University
Stephen S. Mick, Ph.D.
Virginia Commonwealth University
Michael A. Morrisey, Ph.D.
University of Alabama—Birmingham
Dawn Oetjen, Ph.D.
University of Central Florida
Peter C. Olden, Ph.D.
University of Scranton
Lydia M. Reed
AUPHA
Sharon B. Schweikhart, Ph.D.
The Ohio State University
Nancy H. Shanks, Ph.D.
Metropolitan State College of Denver
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MA NAG E RI A L
EPI DEMIOLO GY
SECOND EDITION
Steven T. Fleming, PhD
HealthAdministrationPress,Chicago
AsscociationofUniversityProgramsinHealthAdministration,VA
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Library of Congress Cataloging-in-Publication Data
Fleming, Steven T., 1950–
Managerial epidemiology : concepts and cases / by Steven Fleming. — 2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-56793-292-8 (alk. paper)
ISBN-10: 1-56793-292-4 (alk. paper)
1. Health services administration. 2. Epidemiology—Methodology. I. Title.
[DNLM:1. EpidemiologicMethods.2. HealthServicesAdministration. WA950F598m2008]
RA971.F54 2008
614.4—dc22
2007046084
Find an error or typo? We want to know!
Please email it to [email protected], and put “Book Error” in the subject line
ThepaperusedinthispublicationmeetstheminimumrequirementsofAmericanNationalStandard
for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI Z39.48-
1984.∞™
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To my loving wife Alayne, my very best friend of 35 years, confidante,
and consultant extraordinaire. Thank you for sharing my life with me.
To a great mentor and brilliant theorist, Avedis Donabedian.
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BRIEF CONTENTS
FOREWORD...........................................................................................xv
PREFACE............................................................................................xvii
II CONCEPTS,PRINCIPLES,ANDAPPLICATIONS
1 An Introduction to Managerial Epidemiology ............................3
2 Infectious Disease Epidemiology ...............................................17
3 Measuring and Interpreting Morbidity .....................................43
4 Healthcare Planning and Needs Assessment ..............................67
5 Quality of Care Measurement....................................................97
6 Mortality and Risk Adjustment................................................125
7 Descriptive Epidemiology: Time, Place, Person.......................153
III EPIDEMIOLOGYANDFINANCE
8 Epidemiology and Financial Management ..............................177
9 Cost-Effectiveness Analysis.......................................................205
III EVIDENCE-BASEDMANAGEMENTANDMEDICINE
10 Statistical Tools.........................................................................237
11 Case Control Studies................................................................267
12 Cohort Studies.........................................................................295
13 Randomized Clinical Trials ......................................................321
14 Clinical Epidemiology and Decision Making...........................353
IV APPLICATIONSOFEPIDEMIOLOGYTOSPECIFICDISEASES
15 Cardiovascular Disease.............................................................387
16 Human Immunodeficiency Virus Infection..............................417
17 Alzheimer’s Disease..................................................................441
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DETAILED CONTENTS
FOREWORD...........................................................................................xv
PREFACE............................................................................................xvii
I CONCEPTS,PRINCIPLES,ANDAPPLICATIONS
1 An Introduction to Managerial Epidemiology.............................3
Case Study 1.1. Group Health East.............................................7
2 Infectious Disease Epidemiology................................................17
Agent, Host, and Environment..................................................18
Transmission...............................................................................22
Prevention..................................................................................25
Case Study 2.1. Food Poisoning Outbreak at 29
Bluegrass Hospital...............................................................29
Epidemic Investigation...............................................................30
Case Study 2.2. Outbreak of Influenza in a
New York Nursing Home....................................................36
3 Measuring and Interpreting Morbidity......................................43
The Nature and Definition of Disease........................................43
Natural History of Disease.........................................................44
Sources of Morbidity Data.........................................................46
Measuring Morbidity..................................................................47
Case Study 3.1. Product Lines for Group Health East..............51
Screening....................................................................................53
Case Study 3.2. Breast Cancer Screening...................................56
Case Study 3.3. Prostate Cancer Screening................................59
4 Healthcare Planning and Needs Assessment ..............................67
Community Health Planning Tools and Benchmarks................70
Case Study 4.1. Eastern Kentucky Health..................................73
Institutional Planning.................................................................75
Case Study 4.2. Determining Bed Demand for Cardiac Patients
Age 65–84...........................................................................76
Strategic Planning Model...........................................................81
Marketing...................................................................................82
Needs Assessment.......................................................................84
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