Name:
1
HCA 202 Epidemiological Concepts for Health Care Managers
November 22, 2005: Due 10pm November 28, 2005
Exam 3 Take Home
Insert your name in the header above. This is a 4-part exam that tests knowledge of rates, how
they can be used, strategic planning, quality improvement and infectious disease. Please
complete the assignment in word and excel formats and bring them to class. This is an open
notes exam, but please work on your own. You should have all the materials needed to complete
the exercise. Download this exam and use this as your answer sheet. Type out all of your
responses. For the control chart exercise, you may use may use Excel. Send an email copy of
you Excel work and attach a hard copy. If you choose to, you may plot the control chart by hand.
Turn in all work related to the exam. Contact me if you have any problems. Bring all of your
solutions to class on Wednesday, December 1.
A. Community Assessment (Please note, all figures used in this assignment are fictitious). (15
points)
An analysis of records examined the numbers of persons who were diagnosed with diseases of
the heart to compare the five year proportionate mortality ratio between Nevada and nationally.
Calculate the Odds Ratio of the difference in mortality rates for diseases of the heart (CHD)
between Nevada and the national comparison. Complete this table the same way you would a
case-control odds ratio table.
Exposure
Number of deaths from CHD per 100,000
Nevada
U.S.
485
270
A
C
Exposures to CHD per 100,000 population
Number of cardiologists/100,000 population
Medical school graduates/100,000 population
B
D
5,000
4,500
2.7
4.2
5.8
6.4
1. Calculate the odds of deaths to exposures from diseases of the heart in Nevada compared to
odds of deaths to exposures nationally (use odds ratio calculations to determine quantitative
analysis and state your answer quantitatively)? Quantify your findings. (5 points)
2. Give an assessment on the physician coverage for Nevada for treating CHD and for
healthcare in general? (2 points)
3. Assume the role of an administrator of a cardiology clinic. Identify two opportunities and two
threats related to the information above. (4 points)
4. How could disease management help the patient avoid acuity of heart disease issues? What
would you recommend in terms of disease management? (4 points).
Name:
2
B. In an examination of hospitals in both the Southern and Northern part of the state, the
following observations were made. (20 points)
Measure
Northern Nevada
Occupancy rate
For profit hospitals
70%
Non-profit hospitals
65%
County hospitals
85%
Average length of stay:
For-profit hospitals
4.5 days
Non-profit hospitals
4.0 days
County Hospitals
4.5 days
Med-Surg Nurse to patient ratios
For-profit hospitals
1:8
Non-profit hospitals
1:7
County hospitals
1:6
ICU Nurse to patient ratios
For-profit hospitals
1:2
Non-profit hospitals
1:2
County hospitals
1:2
Average physician rounds per day/patient
2.0
Average Patient Satisfaction Rate:
For-profit hospitals
80 percentile
Non-profit hospitals
80 percentile
County hospitals
60 percentile
Reported number of medical errors per
admission:
For-profit hospitals
Non-profit hospitals
County hospitals
Rate of Return on Investment1
For-profit hospitals
1.2
Non-profit hospitals
1.1
County hospitals
1.0
Annual rate of population growth
1.5%
Unemployment rate
5%
1Rate of return refers to amount made per dollar spent
Southern Nevada
90%
95%
100%
3.5 days
4.0 days
4.5 days
1:10
1:8
1:7
1:3
1:2
1:1
1.0
75 percentile
95 percentile
80 percentile
1.5
1.3
.80
5%
3.1%
1. Identify the strengths and weaknesses of each type of hospitals in both parts of the state?
Are the opportunities for the southern hospitals better than the northern ones? Explain why.
(8 points)
2. Identify one general external environmental measure and one health care external
environmental measure that may impact the performance of the hospitals in both areas of the
state. (4 points)
3. Using Donebedian’s model of quality, indicate which of the measures identified above are
likely to affect a) structure quality, b) process quality and c) outcome quality. Explain areas for
improvement for structure, process, and outcomes for the hospitals in each group. (Give
examples so I know what you are talking about). (8 points)
Name:
3
C. SWOT Analysis (25 points)
A group of young hospital cardiologists at Vegas Memorial Hospital (VMH) – a public, non-profit facility – are
considering opening a specialty heart center in direct competition with VMH. The physicians have been
unhappy with the clinical practices of their more experienced, but technologically entrenched mentors at
VMH. Requests by the younger cardiologists to upgrade the hospital’s cardiology technology have been
turned down by administrators due to lack of support from their older peers. The senior physicians prefer
their older methods pointing out their equal effectiveness than the new technology proposed by the younger
group. In particular, the senior physicians have been worried that investment in the new technology is too
expensive for the non-profit hospital. Hospital management has relied on the input from their more seasoned
medical staff. The hospital also points out that they have limited space to accommodate the younger
physician’s request to upgrade the hospital located in the inner-city.
The younger physicians, with the backing of a proposed new medical center - have organized to develop
Cactus Cardiology Associates, a specialty cardiology center. The physicians have been pursued by Resorts
Medical Center a new, for-profit hospital located at the junction near 1-15 and 215. The location is in a
rapidly developing area and has room for expansion.
The older physicians have organized to undermine the younger physician’s credibility with the existing
hospital patients and insurance payers. Currently, VMH has an exclusive contract with Profiteering Health
Services, the region's largest managed care provider of HMO and PPO products. It also controls 60% of the
Medicare HMO market, the fastest growing Medicare sector due to its more favorable prescription drug plan
compared to traditional Medicare coverage. However, Local 666, the union representing 60% of the region's
gaming employees has negotiated with CCA and its affiliates to be added to its list eligible providers. The
average age of the union's membership is 44 years of age. But the company also provides retirees with
supplemental coverage that provides a better prescription drug benefit than the current Medicare HMO plan.
Below is additional information regarding this case study.
Age Demographics of area growth and relative risk for coronary heart disease.
Age
1990
2000
45 and younger
46 and over
% of elderly (65+) with supplemental Medicare benefits
60%
40%
68%
55%
45%
75%
Relative Risk for
Coronary Heart Disease
0.25
4.00
Number of cardiology/cardiovascular procedures per 1,000 age 65+:
U.S. – 65
Las Vegas – 50
Average length of stay for triple by-pass procedures for Vegas Memorial Hospital: 7.8 days
Estimated average length of stay for triple by-pass procedures for Cactus Cardiology: 4.5 days
From the following information, please indicate whether a factor is a strength (S),
weakness (W), opportunity (O), or threat (T), or no-factor (N)
1. Rate of population growth for target population.
2. Practice standards for younger physicians.
3. Average length of stay for triple by-pass services.
4. Location of CCA
5. Resorts Medical Center
6. Relative risk for coronary heart disease among target population.
Vegas
Memorial
Cactus
Cardiology
7. Impact of Profiteering Health Services
8. Impact of Local 666 Union
9. Quantifiably describe the relative risk for the 45 and younger population and the 46 and over
population. (2 points)
10. Give a brief assessment of the types of technology that are likely to impact this case? (3
points)
11. Based on the information, which of the groups are most likely to succeed and why? (4 points)
Name:
4
D. Control Chart Exercise (40 points) (use infectious disease case study)
You are an epidemiologist for the County Health District and you have been tracking some disturbing information about outbreaks of
staphylococcus aureus bacteria infections at area hospitals. After noticing an increase in the prevalence of staph infections in area hospitals
during the last quarter of the previous year, you begin monitoring the information using data collected bi-weekly. You have concentrated on the
two largest hospitals in the county to determine whether there are noticeable differences between those two hospitals. You have chosen these
hospitals because they are of similar size and provide similar services, although County General Medical Center (CGMC) typically treats more of
the uninsured patients, therefore, sicker patients. Buggerville Medical Center (BMC) is a for-profit hospital operated by a national chain. It is the
most profitable hospital within its chain. In addition, the hospitals use many of the same physicians. Complete the control chart below. Based on
your control chart, answer the additional questions below the data to complete this assignment.
Week
Hospital
inpatient
census
Reported
Staph
infections
Prevalence
rate of staph
infections
County
General
Hospital
Census
Staph infections Prevalence
rate of staph
infections
Buggerville
Medical Center
Census
# of
Buggerville
staph
infections
Prevalence
rate of staph
infections
Sept. 30
1510
150
220
20
370
45
Oct. 31
Nov. 30
1980
2050
200
240
300
270
21
22
375
410
40
53
Dec. 31
2640
300
250
19
380
60
Jan. 15
2800
290
310
15
400
45
Jan. 31
Feb. 15
2760
2890
325
380
270
290
30
45
385
390
55
69
Feb. 28
Mar. 15
3010
3200
480
550
300
350
60
70
400
250
78
95
Mar. 31
Apr. 15
3500
3250
580
465
370
280
55
38
200
195
70
40
Apr. 30
May. 15
2600
2580
300
250
220
210
22
18
190
250
32
25
May. 31
Jun. 15
2050
1900
250
160
195
175
20
15
300
310
18
15
Jun. 30
1575
120
180
10
300
12
Name:
5
1. Develop Centerlines, Upper Centerlines and Lower Centerlines all the hospitals, CGMC, and
Buggerville Medical Center. (20 points)
2. Plot and graph the rates for the hospital and each of the cardiology groups. (5 points)
3. What do the graphs indicate? Make sure to describe the trends from all three groups from the
last quarter of the previous year, then throughout the study period. Describe any differences
you found between the two large hospitals. Make sure to observe any trends. Are there any
differences in the trends in the outbreaks at these facilities? Are there similarities or
differences between either of the two large hospitals in comparison to all of the hospitals you
have tracked? (5 points)
4. How might an outbreak at one hospital impact an outbreak at another hospital? (2 points)
5. Did either of the hospitals appear to contribute to the overall outbreak at a higher rate than
some of the others? What can you discern regarding the hospitals’ response to the
outbreak? Make sure to consider facts presented in the case above. (4 points)
6. How do hospitals generally deal with outbreaks and infectious diseases? (4 points)
7. EXTRA CREDIT: Since you are the Epidemiologist studying this outbreak, if there were any
differences between the hospitals, what methods would you implement to help control this
outbreak. (2 points)
Note: if you are completing the control chart on Excel, there are a couple of ways to indicate the
Centerline, Upper Centerline, and Lower Centerline. One is to complete the bar graphs for each
hospital on Excel, then using the drawing tool from the toolbar menu in Excel physically place the
Centerline, UCL and LCL for each hospital on the graph. Make sure to use the same color for
each hospital and a solid line for the centerline and a dotted line for the UCLs and LCLs.
The other method is to set up a spreadsheet similar to the one that I used in the solution for the
control chart homework assignment on the HTML link. Each month has a corresponding entry for
each of the hospitals in terms of monthly observations, centerline, UCL and LCL.