Managerial Epidemiology for Health Care Organizations

A new edition of the comprehensive and practical introduction to managerial epidemiology and population health

Managerial Epidemiology for Health Care Organizations has introduced the science of epidemiology and population health to students and practitioners in health management and health services for over sixteen years. The book covers epidemiology basics, introducing principles and traditional uses, and then expertly showing its contemporary uses in planning, evaluating, and managing health care for populations and the practical application in health care management. The book’s practical and applied approach, with real-world examples sprinkled throughout, has made it the go-to book for managerial epidemiology and population health courses.

Since the second edition was published in 2005, the health care landscape has undergone significant changes. Passage of the Patient Protection and Affordable Care Act and the incorporation of ICD-10 have impacted the entire health care system. This newly updated third edition will address these two significant changes, as well as several others that have taken place. It also features new chapters on reimbursement approaches and managing infection outbreaks, as well as updates to the four case study chapters that anchor the book.

• Witness how epidemiological principles are applied to the delivery of health care services and the management of health care organizations
• Examine the major changes brought on by the passage of health care reform and incorporation of ICD-10
• Discover the core epidemiology principles and see how they are applied in planning, evaluating, and managing health care for populations

If you’re a student or professional in any area of health services, including health administration, nursing, and allied health, then Managerial Epidemiology for Health Care Organizations is the perfect book for you. It successfully demonstrates how health care executives can incorporate the practice of epidemiology into their various management functions and is rich with current examples, concepts, and case studies that reinforce the essential theories, methods, and applications of managerial epidemiology.

PETER J. FOS is professor of Health Policy and Systems Management at Louisiana State University Health Sciences Center, School of Public Health.

DAVID J. FINE is former president and CEO of Catholic Health Initiatives (CHI) Institute for Research and Innovation. Previously he served at St. Luke's Health System (SLHS) as president, CEO, and principal executive.

MIGUEL A. ZÚNIGA is associate professor and chair of the Department of Health Services and Promotion in the College of Health Sciences at Sam Houston State University.

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

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

Descriptive Information 25

Other Descriptive Variables 41

Sources of Descriptive Information 43

Reportable Diseases 47

Managerial Applications 47

Summary 52

Study Questions 52

3 Measurement of Health 55

Introduction 56

Measures 56

Measuring Morbidity 65

Measuring Mortality 73

Measuring Health 83

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

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

Risk Adjustment 136

Summary 139

Study Questions 140

6 Medical Management in Population Health Care 149

Introduction 150

Medical Management 151

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

Marketing and Population Health 202

Market Research 204

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

Quality of Health Care 241

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 Health 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

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