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List of Tables, Figures, and Exhibits xiii Preface xxiii The Authors xxvii 1 Epidemiology in Health Care Administration 1 Introduction 2 Philosophical Framework 5 Focus and Uses of Epidemiology 6 Observational Epidemiology • Experimental Epidemiology • Preventive Medicine Health Care Reform 8 The Concept of Populations and Communities 11 Managing Health Care for Populations and Communities 12 Role of Epidemiology 14 Summary 16 Study Questions 16 2 Description of Health 19 Introduction 20 Health and Disease 21 Definitions • International Classification of Diseases and Related Problems • Health Status Descriptive Information 25 Person Variables • Place Variables • Time Other Descriptive Variables 41 Sources of Descriptive Information 43 Vital Statistics • Medical Records Reportable Diseases 47 Managerial Applications 47 Summary 52 Study Questions 52 3 Measurement of Health 55 Introduction 56 Measures 56 Counts • Rates • Ratios • Proportions Measuring Morbidity 65 Incidence Rate • Prevalence Rate • Period Prevalence Rate Measuring Mortality 73 Death Rates • Potential Years of Life Lost Measuring Health 83 Survival Rate • Health–Related Quality of Life Other Rates 85 Summary 86 Study Questions 86 4 Studying the Health Needs of Populations 89 Introduction 90 Risk and Causation 91 Study Designs 93 Experimental • Clinical Trials • Observational • Descriptive Studies • Cross–Sectional Studies • Ecological Studies • Prospective Studies • Retrospective Studies Association of Risk Factors and Health and Disease 103 Measuring Association in Prospective Studies 104 Measuring Association in Retrospective Studies 108 Application to Population Health Management 110 Sampling 113 Summary 115 Study Questions 115 5 Standardizing Population Health Information 117 Introduction 118 Stratification 120 Matching 121 Standardization of Information 123 Direct Method of Standardization • Indirect Method of Standardization Risk Adjustment 136 Summary 139 Study Questions 140 6 Medical Management in Population Health Care 149 Introduction 150 Medical Management 151 Clinical Effectiveness • Validity • Managerial Aspects of Validity • Reliability • Impact of Test Information • Clinical Practice Analysis Chronic Disease Management 169 Summary 170 Study Questions 171 7 Management of Infectious Epidemics 175 Introduction 175 Infectious Disease Epidemiology 176 Infectious Epidemics Health Care–Associated Infections 182 Surveillance 186 Summary 188 Study Questions 188 8 Reimbursement Approaches and Marketing 191 Introduction 192 Reimbursement Methods 193 Current Procedural Terminology • Capitation • Diagnosis–Related Groups • Outpatient Prospective Payment System • Inpatient Rehabilitation Facility Prospective Payment System • Skilled Nursing Facility Prospective Payment System • Home Health Prospective System • Resource–Based Relative Value Scale • Accountable Care Organizations • Pay for Performance Marketing and Population Health 202 Marketing • The Role of Marketing • Marketing the Health Care System Market Research 204 Sampling • Market Research Data Analysis • Patient Satisfaction • Demand Estimation • Validity and Reliability of Market Research Summary 214 Study Questions 215 9 Population Health Outcomes and Quality of Care 219 Introduction 220 Assessing Health Outcomes 220 Health Status Assessment 225 Patient Satisfaction and Patient Expectations Assessment 227 Monitoring Health Outcomes 231 Managing with Health Outcomes 232 Uses of Outcomes Assessment • Benchmarking • Best Practices and Practice Guidelines • Application of Best Practice Assessment • Root Cause Analysis Quality of Health Care 241 Rapid Improvement Cycle Process • Statistical Process Control • The Malcolm Baldrige National Quality Program Summary 250 Study Questions 251 10 Economic Analysis of Health Care for Populations 253 Introduction 254 Economic Evaluation 257 Cost Analysis 259 Cost–Benefit Analysis 261 Cost–Effectiveness Analysis 262 Cost–Utility Analysis 264 Discounting 265 Sensitivity Analysis 269 Burden of Disease Analysis 269 Examples of Economic Analysis 272 Summary 275 Study Questions 276 11 Expanding Hospital Care Services 281 Introduction 282 Service Area Population 283 Hospital Care Utilization 284 Discharges 287 Length of Hospital Stay 289 Hospital Description 292 Payment Sources 293 Service Area Population Health 296 12 Long–Term Care 303 Introduction 303 Population Characteristics 304 Westside Elderly Care, Inc. 308 Utilization of Services 308 Staffing 319 13 Emergency Department Services 321 Introduction 321 Emergency Department Utilization 322 Payment Sources 331 Time Analysis 332 Primary Diagnosis at Arrival 336 Patient Disposition 337 14 Physician Practices 341 Introduction 342 Population Characteristics 342 Resource Utilization 343 Time Since Last Visit 346 Insurance Coverage 349 Reason for Visit 351 Preventive Care Visits 355 Chronic Conditions 356 References 359 Index 375