Posted: March 1st, 2023

saint HCM530 all case study except module 7

hCM530 Case Study 1 Outbreak of Influenza in a Kentucky Nursing Home Assume that an outbreak of Influenza A occurred among 400 residents of a New York Nursing Home during December 2006 and January 2007, despite the vaccination of 375 of them between mid-October and mid-November of 2006. The residents, 70% of whom were female, had a mean age of 85 years and shared common recreational and dining areas. (Textbook Case Study 2.2) Case Questions: Base your reply upon this influenza outbreak case, research of influenza, and proposed solutions. You are to write a 2-3 page paper in Help write my thesis – APA formatting that addresses the following questions. Note: A minimum of two references should be used, which should include your textbook and the CDC, and others that support your responses in your paper. This is a paper, so your answer should not be numbered, but rather it should use titles and subtitles. 1. If 75 of the residents developed influenza-like illness (ILI), what proportion of the residents became sick? 2. Of those with ILI, 40 developed pneumonia, 25 required hospitalizations, and two died. What proportion of those with ILI developed pneumonia? What percent of those with ILI and pneumonia were hospitalized? What proportion of those with ILI died? 3. Of the 375 residents who were vaccinated, 60 developed ILI. Of the 25 residents who were not vaccinated, 20 developed ILI. What percent of vaccinated residents developed ILI? What percent of unvaccinated residents developed ILI? How many more times higher is the rate of ILI among those who were unvaccinated compared to those who were vaccinated? 4. Of the 375 vaccinated residents, 35 developed pneumonia following ILI compared to 15 residents among the 25 who were not vaccinated. What percent of vaccinated residents developed pneumonia following ILI? What percent of unvaccinated residents developed pneumonia following ILI? How many more times higher is the pneumonia following ILI among those who were unvaccinated compared to those who were vaccinated? 5. What was the vaccine efficacy for preventing LIL and pneumonia?Case study 2Needs Assessment for Stroke Services in Ontario, Canada The Queen’s Health Policy Research Unit (QHPRU) estimated the need for stroke services in Ontario, Canada using measures of prevalence and incidence of (1) modifiable and nonmodifiable risk factors for stroke; (2) acute cases of stroke; (3) major sequelae of stroke (Hunter D , 2000 and Hunter D, 2004). They identified the effective health services that are targeted at each of these three dimensions, and linked these steps to estimate need for health services. They compared the estimate of need for health services to compiled measures of levels of stroke-related health services in Eastern Ontario to see if there was a gap (unmet need) or surplus (overmet need) of these services. The numbers below have been changed slightly from the original source. (Textbook Case Study 4.3) Download Case Reports: http://mcgill.academia.edu/LorieKloda/Papers/78206/Creation_and_pilot_testing_of_StrokEngine_A_stroke_rehabilitation_intervention_website_for_clinicians_and_familiesCase Questions: Answer the case questions, with research from your book, CDC, NIH and other quality sources to determine answers and solutions. You are to write a 2-3 page paper in Help write my thesis – APA formatting that addresses the following questions. Note: A minimum of two references should be used, which should include your textbook and the CDC, and others that support your responses in your paper. This is a paper, so your answer should not be numbered, but rather it should use titles and subtitles. 1. Risk factors for stroke include heavy alcohol consumption, atrial fibrillation, diabetes, hypercholesterolemia, hypertension, obesity, low physical activity, smoking, ischemic heart disease, transient ischemic attack. Where might QHPRU get estimates of the incidence of these conditions? 2. For each risk factor, or stroke sequelae, QHPRU listed the kind of intervention that would be effective, and the proportion of people for whom this intervention would be appropriate. According to Table 4.3, which three interventions are appropriate for hypercholesterolemia, and for what proportion of high-risk individuals? 3. The following types of interventions were recommended for acute stroke services: (a) surgical intervention (carotid endarterectomy); (b) thrombolytic therapy; (c) imaging of the brain, either computed tomography (CT) or magnetic resonance imaging (MRI); (d) non-invasive imaging of the vessels (ultrasonography or magnetic resonance angiography); (e) invasive imaging of the vessels (cerebral angiography); (f) rehabilitation therapy. For what percent of at-risk individuals are these services recommended? 4. Estimates of people in Eastern Ontario with hypercholesterolemia are as follows: aged 25-44: 30,000 men and 13,000 women; aged 45-64: 33,000 men and 42,500 women; aged 65 and above: 17,000 men and 42,000 women. How many residents in Ontario will need fasting lipoprotein analysis and dietary and pharmacologic interventions for hypercholesterolemia? 5. It is estimated that Eastern Ontario provides dietary and pharmacologic intervention for hypercholesterolemia to 66,000 and 15,500 patients respectively. What is the level of unmet need in terms of the number of patients not receiving each of these two recommended interventions? What percent of need is not currently being met in Eastern Ontario? 6. The incidence of acute stroke cases was estimated at 3,500 cases, 100 of whom died before reaching the hospital. The prevalence of chronic stroke cases was estimated to be 4,300. Use Table 4.4 to estimate the number acute and chronic stroke cases needing core stroke services, and services for chronic stroke and disability. 7. It is estimated that Eastern Ontario provides thrombolytic therapy and carotid endarterectomy to 50 and 200 patients respectively. CT and MRI brain imaging is provided to 1,000 and 150 patients respectively. Non-invasive and invasive imaging of the vessels is provided to 425 and 170 patients respectively. Rehabilitation is provided to 1,400 acute stroke survivors, and homecare services are provided to 1,400 chronic stroke with disability patients. What is the level of unmet need in terms of the number of patients not receiving each of recommended services for acute or chronic stroke victims? What percent of need is not currently being met in Eastern Ontario? HCM530 Case Study 3 Age and Gender Adjustment in Two Managed Care Organizations The purpose of standardization is to make two or more populations “similar” along dimensions in which they differ. Earlier, we demonstrated two methods of age-adjustment. For example, we know that Florida has proportionately more older folks, and older folks die at higher rates than younger folks. In order to compare the mortality rate of Florida to Alaska, we needed to control for this disparity by adjusting for differences in the age mix of the two states. Conceptually, we can adjust for more than one dimension, e.g., age and gender, if we want to compare two or more populations, know that the age and gender mix will be different in those two populations, and also know that some disease-specific mortality rates depend on both age and gender. Such is the case with cardiovascular disease in two large MCOs, Bluegrass East (BGE) and Bluegrass West (BGW), the former with 100,000 members, and the latter with 120,000 members. Suppose we want to compare the cardiovascular mortality rate of BGE and BGW. Suppose that BGE has a higher proportion of older folks, and a higher proportion of women, than BGW. Assume that the crude disease-specific mortality rate for cardiovascular disease is 290 (per 100,000) in BGE and 160 (per 100,000) in BGW. (Textbook Case Study 6.2) Case Questions: Answer the case questions, with research from your book, CDC, NIH and other quality sources to determine answers and solutions. You are to write a 2-3 page paper in Help write my thesis – APA formatting that addresses the following questions. Note: A minimum of two references should be used, which should include your textbook and the CDC, and others that support your responses in your paper. This is a paper, so your answer should not be numbered, but rather it should use titles and subtitles. 1. From these statistics alone, which MCO has the higher cardiovascular mortality rate? 2. The member mix in BGE and BGW is quite different. In BGW, 90% of the population is less than 55 years old compared to 77% in BGE. Refer to Table 6.7 to guide the calculation of age-adjusted cardiovascular mortality rates using the direct age-adjustment technique and the U.S. population as the standard. With age-adjusted rates, which MCO has the higher mortality rate? 3. Now assume that 60% of the members in BGW are men compared to 40% in BGE. Men have higher cardiovascular mortality rates than women. Refer to Table 6.8 to calculate age and Gender adjusted cardiovascular mortality rates. With age- and gender-adjusted rates, which MCO has the higher cardiovascular mortality rate? HCM530Case Study 4Risk Adjustment with Multivariate Techniques (New York)The state of New York (https://monkessays.com/write-my-essay/health.state.ny.us/nysdoh/consumer/heart/1996-98cabg.pdf) hasreported risk adjusted mortality statistics for coronary artery bypass graft surgery (CABG) for a numberof years, as discussed earlier in the text. New York uses the second major approach to risk adjustment, amultivariate model. Such models control for different kinds of patient characteristics that are likely toinfluence mortality. Table 4.1 reports the multivariate model used to calculate this risk-adjustedmeasure. (Textbook Case Study 6.4)Table 4.1: Multivariable risk factor equation for CABG hospital deaths in New York State in 1998.Logistic RegressionPatient Risk Factor Prevalence (%) Coefficient P-Value Odds RatioDemographicsAge …. 0.0671 <0.0001 1.069Female Gender 28.92 0.5105 <0.0001 1.666Hemodynamic StateUnstable 1.32 1.0423 <0.0001 2.836Shock 0.45 1.8458 <0.0001 6.333ComorbiditiesDiabetes 30.91 0.3607 0.0010 1.434Malignant Ventricular Arrhythmia 2.228 0.9759 <0.0001 2.654COPD 15.97 0.5012 <0.0001 1.651Renal Failure (no dialysis),Creatinine > 2.5 1.89 0.9213 <0.0001 2.513Renal Failure requiring Dialysis 1.89 0.9213 <0.0001 5.688Hepatic Failure 0.10 3.0535 <0.0001 21.190Severity of Atherosclerotic ProcessAortoiliac Disease 5.42 0.5481 0.0006 1.730Stroke 7.01 0.4775 0.0016 1.621Ventricular FunctionEjection Fraction <20 1.77 1.4235 <0.0001 4.151Ejection Fraction 20-29 7.40 0.8183 <0.0001 2.267Ejection Fraction 30-39 14.49 0.6186 <0.0001 1.856Previous Open Heart Operations 5.98 0.6800 <0.0001 1.974Intercept = -9.4988C Statistic = 0.793Case Questions: Answer the case questions, with research from your book, CDC, NIH and other quality sources to determine answers and solutions. You are to write a 2-3 page paper in Help write my thesis - APA formatting that addresses the following questions. Note: A minimum of two references should be used, which should include your textbook and the CDC, and others that support your responses in your paper. This is a mpaper, so your answer should not be numbered, but rather it should use titles and subtitles.1. Which factors are supposedly related to CABG morality?2. Which factors are the most strongly related to CABG mortality?3. How could one derive an expected mortality rate from the multivariate model?HCM530 Case Study 5 Planning with Electron-Beam Computed Tomography (EBCT) The use of electron-beam computed tomography (EBCT) for screening of asymptomatic high risk cardiac population to assess for developing coronary heart disease is a new low risk alternative to the traditional invasive heart catheterization. The cardiac CT is recommended by the American College of Cardiology (ACC) as a secondary prevention test to screen prior to a myocardial infarction and death. Garcia (2005) cites that 1 in 20 emergency department (ED) patients present with chest pain and 3-5% of heart attacks have been missed by ED physicians. Another 20-40% of patients who have an invasive heart catheterization are negative. He recommends the cardiac CT as a method to solve some of these issues; however, continued validation is needed. The CT is not an answer for all patients, such as the obese, where visualization is difficult, or those with irregular heart rhythms. Hospitals and clinics across the nation are now purchasing the EBCT scanners. This case study will discuss the screening ability and healthcare planning challenges when bringing in new technology to the healthcare market. A recent purchase of an EBCT scanner was installed in a central U.S. clinic which serves a 300-bed tertiary hospital. The hospital and clinic took great care in training all staff in its use and patient preparation methods, including running a pilot on several local volunteers. Three months post pilot Case Questions: Answer the case questions, with research from your book, CDC, NIH and other quality sources to determine answers and solutions. You are to write a 2-3 page paper in Help write my thesis - APA formatting that addresses the following questions. Note: A minimum of two references should be used, which should include your textbook and the CDC, and others that support your responses in your paper. This is a paper, so your answer should not be numbered, but rather it should use titles and subtitles. 1. What are the sensitivity, specificity, and predictive values of EBCT? 2. Compare Valanis’s criteria for a good screening program with the eight criteria which the ACC/American Heart Association (AHA) panel proposed for selection of a screening procedure. 3. Provide descriptive epidemiology of this IL region to support the need to purchase a cardiac CT 4. (Health care planning) What should be done at this point to encourage use of this screening/diagnostic test for coronary heart disease?

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