Introduction to Healthcare and Public Health in the US: Discussion Questions:
The Evolution and Reform of Healthcare in the US
Discussion Questions with Expected Outcomes
Discussion questions (for individual assignments or small group discussion):
Lecture a
1. What is evidence based practice?
Expected Outcome for Discussion: Evidence Based practice (EBP) is a method of
clinical practice that involves "the conscientious, explicit and judicious use of current
best evidence in making decisions about the care of the individual patient.”
Suggested learning outcome: Student is able to identify distinct styles of clincal practice,
and define EBP.
Objective(s): 1
Lecture(s)/Slide(s): a3, 4
2. Discuss how clinical decision support systems assist in the practice of
medicine
Expected Outcome for Discussion: Clinical decision support systems (CDSS) can help
in the practice of medicine in many ways. Administrative assistance includes billing,
coding, documentation, and referrals. CDSS can help to manage complexity, by
tracking orders and referrals, and reminding clinicians to adhere to preventive care
guidelines. CDSS can also help with cost control by monitoring medication orders, and
avoiding duplicate or unnecessary tests. Decision support functionality includes
supporting clinical reasoning, and promoting the use of best practices.
Objective(s): 1
Lecture(s)/Slide(s): a6, 7
3. What is the hierarchy of evidence? Why is it necessary to have a hierarchy?
Expected Outcome for Discussion: Literature is ranked in terms of quality of studies in
a hierarchy. Hierarchies allow grading of studies with different methodologies, and
provide a framework that can be used during the development of systematic review
protocols to help determine which study design is “better”.
Objective(s): 1
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
The Evolution and Reform of Healthcare in the US
1
This material (Comp1_Unit9) was developed by Oregon Health & Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
Lecture(s)/Slide(s): a8
4. What is bias? How can bias be reduced?
Expected Outcome for Discussion: Bias: Inaccuracies that produce a consistently false
pattern of differences between observed and true values
Blinding: Attempt to eliminate bias by hiding the intervention from the patient, clinician,
and researchers who are interpreting results
Objective(s): 1
Lecture(s)/Slide(s): a10
5. Compare and contrast a systematic review and a meta-analysis.
Expected Outcome for Discussion: Systematic review: Authors have systematically
searched the medical literature for the topic under discussion
Meta-analysis: A systematic review that uses quantitative methods to summarize the
results
Objective(s): 1
Lecture(s)/Slide(s): a11
6. In your opinion, what is the fundamental difference between a case control and
a cohort study?
Expected Outcome for Discussion: A case control study is retrospective while a cohort
study is prospective.
Objective(s): 1
Lecture(s)/Slide(s): a9
7. When researching a question, what does the term ‘PICO’ mean?
Expected Outcome for Discussion:
P = Patient : What are the characteristics of the patient/population/problem?
I = Intervention: What is the intervention, prognostic factor or exposure?
C = Comparison: What is the main alternative to compare with the intervention?
O= Outcomes: What is the measurement or improvement?
Objective(s): 1
Lecture(s)/Slide(s): a13
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
The Evolution and Reform of Healthcare in the US
2
This material (Comp1_Unit9) was developed by Oregon Health & Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
Lecture b
1. What are clinical practice guidelines?
Expected Outcome for Discussion: Practice guidelines are systematically developed
evidence-based recommendations
Objective(s): 1, 2
Lecture(s)/Slide(s): b3, 4
2. How do clinical practice guidelines help clinicians make good decisions?
Expected Outcome for Discussion: Clinical practice guidelines help to achieve
standardization, and allow dissemination of best practices.
Objective(s): 1, 2
Lecture(s)/Slide(s): b4
3. What is the U.S. Preventive Services Task Force (USPSTF)?
Expected Outcome for Discussion: The USPSTF is an independent panel of experts in
prevention and evidence-based medicine. It is composed of primary care providers, and
conducts scientific evidence reviews of a broad range of clinical preventive health care
services. The USPSTF also develops recommendations for patient care.
Objective(s): 1, 2, 3
Lecture(s)/Slide(s): b5
Lecture c
1. What are the benefits of improving quality in healthcare?
Expected Outcome for Discussion:
Benefits include:
Better patient outcomes (patient health)
Better system performance (patient care)
Better professional development (clinician learning)
Objective(s): 1
Lecture(s)/Slide(s): c4
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
The Evolution and Reform of Healthcare in the US
3
This material (Comp1_Unit9) was developed by Oregon Health & Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
2. What is AHRQ? What does it do?
Expected Outcome for Discussion: Agency for Healthcare Research and Quality
(AHRQ) has a mission: “to improve quality, safety, efficiency, and effectiveness of
health care for all Americans”. AHRQ focuses on:
Safety and quality: Reduce risk of harm
Effectiveness: Improve health care outcomes
Efficiency: Transform research into practice
Objective(s): 1, 3
Lecture(s)/Slide(s): c5
3. How can we measure quality?
Expected Outcome for Discussion: Quality measures are used to identify trends in
quality. These can be process or outcome measures.
Objective(s): 1, 2
Lecture(s)/Slide(s): c6
4. What is a PDSA cycle?
Expected Outcome for Discussion: PDSA: Plan-Do-Study-Act cycle methodology for
quality improvement.
Student outcome for this question: Suggest a quality measure (e.g. laboratory test for
control of diabetes) and have students run discuss how they would apply the elements
of a PDSA cycle.
Objective(s): 1
Lecture(s)/Slide(s): c6
5. What is comparative effectiveness research (CER)? What can CER help to
prove?
Expected Outcome for Discussion: CER is research that looks at evidence and
compares the benefits and harms of alternative methods. CER may provide information
about benefits and harms, can compare costs of different treatments based on
outcomes, and can help patients and physicians choose between treatments
Objective(s): 1, 2, 3
Lecture(s)/Slide(s): c7, 8
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
The Evolution and Reform of Healthcare in the US
4
This material (Comp1_Unit9) was developed by Oregon Health & Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
Lecture d
1. What is a patient centered medical home?
Expected Outcome for Discussion: The PCMH is an approach to providing
comprehensive primary care. It is a health care setting that facilitates partnerships and
collaboration.
Objective(s): 2
Lecture(s)/Slide(s): d5, 6, 7
2. What does “physician directed medical practice” mean?
Expected Outcome for Discussion: A personal physician leads a team of individuals at
the practice level, and the team takes collective responsibility for patient care.
Objective(s): 2
Lecture(s)/Slide(s): d6
3. Discuss methods to make clinical practices more patient-friendly, including
enhanced access models.
Expected Outcome for Discussion: Methods include open-access scheduling,
Expanded hours, Secure messaging and email, Use of personal health records
Objective(s): 2
Lecture(s)/Slide(s): d12
Lecture e
1. Which amendments of the Social Security Act of 1935 attempted to introduce
health care reform? Can you describe the nature of this reform?
Expected Outcome for Discussion: 2 amendments to the Social Security Act of 1935 -Title XVIII, later known as Medicare, and Title XIX, later known as Medicaid
Objective(s): 3
Lecture(s)/Slide(s): e3
2. What are the reforms introduced as a consequence of the Health Insurance
Portability and Accountability Act (HIPAA) in 1996?
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
The Evolution and Reform of Healthcare in the US
5
This material (Comp1_Unit9) was developed by Oregon Health & Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.
Expected Outcome for Discussion: Reforms include portability of health insurance
coverage, standards for protecting privacy and confidentiality of health information.
Objective(s): 3
Lecture(s)/Slide(s): e6
3. Discuss some of the provisions of healthcare reform passed by Congress in
2010
Expected Outcome for Discussion: Provisions include a preexisting condition insurance
plan, health insurance exchanges, no lifetime dollar value limits to health insurance,
preventive services without co-payments, establishing the National Prevention, Health
Promotion and Public Health Council, Medicare reform, care coordination, insurance
reforms, Medicaid drug rebate, and quality improvement measures.
Objective(s): 1, 2, 3
Lecture(s)/Slide(s): e9 - 21
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
The Evolution and Reform of Healthcare in the US
6
This material (Comp1_Unit9) was developed by Oregon Health & Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.