Question

Pls give your answers in well-develope paragraphs and give page on both questions. pls make sure you provide a full page of more on both answers;

1. Describe the interdependent challenges of cost, quality, and access currently facing the US healthcare system.

2. Analyze the implications of the cost, quality, and access challenges for the management of healthcare information system.

Answer 1

1. There are several areas where the quality of American health care is falling short, including underuse, overuse, misuse, and variation in use of health care services.

Underuse of Services: The failure to provide a needed service can lead to additional complications, higher costs, and premature deaths. For example, a study of heart attack patients found that nearly 80 percent did not receive life-saving beta-blocker treatment, leading to as many as 18,000 unnecessary deaths each year. A survey of managed care plans by the National Committee for Quality Assurance (NCQA) found that 60 percent of diabetics age 31 and older had not received a recommended eye exam in the previous year. The same survey reported that 30 percent of women age 52 to 69 had not had a mammogram in the previous 2 years, and 30 percent of women between ages 21 and 64 had not had a Pap smear in the previous 3 years, despite the fact that early screening reduces mortality.

Overuse of Services: Unnecessary services add costs and can lead to complications that undermine the health of patients. For example, half of all patients diagnosed with a common cold are incorrectly prescribed antibiotics. Overuse of antibiotics has been shown to lead to resistance and as much as $7.5 billion a year in excess costs. Another study found that 16 percent of hysterectomies performed in the United States were unnecessary.

Misuse of Services: Errors in health care delivery lead to missed or delayed diagnoses, higher costs, and unnecessary injuries and deaths. A study of New York State hospitals found 1 in 25 patients were injured by the care they received and deaths occurred in 13.6 percent of those cases. Negligence was blamed for 27.6 percent of the injuries and 51.3 percent of the deaths. Based on this study, researchers estimated that preventable errors in hospital care led to 180,000 deaths per year. Researchers estimate that as many as 30 percent of Pap smear test results were incorrectly classified as normal.

Variation of Services: There are significant variations in the practice of medicine across the United States, among regions, and even within communities. For example, hospital discharge rates are 49 percent higher in the Northeast than they are in the West. A person with diabetes is one-and-a-half times as likely to get a needed eye exam in New England than in a Southern state.

Underuse of Services

The failure to provide needed health care services often leads to unnecessary complications, higher costs, and premature mortality. There are numerous examples where services that have proven effective in improving care and often lowering costs are not being used. They include:

Diabetes Care. People living with diabetes require annual eye exams to avoid potential blindness (NIH, 1998). Yet, in its survey of managed care plans, the National Committee for Quality Assurance found that only 40 percent of diabetics age 31 years and older had received an eye exam during the previous year (NCQA, 1997).

Mammograms. Early detection of breast cancer through mammograms can prevent up to 30 percent of breast cancer deaths each year (CDC, 1998). However, NCQA found that 30 percent of women age 52 to 69 in surveyed managed care plans had not received a mammogram in the previous 2 years (NCQA, 1997).

Cervical Cancer Screening. As a result of early detection efforts, the incidence of invasive cervical cancer has decreased (CDC, 1998). Yet in 1996, nearly 30 percent of women between the ages of 21 and 64 had not received at least one Pap smear in the previous 3 years (NCQA, 1997). In 1998, an estimated 13,700 women will be diagnosed with cervical cancer and 4,900 women will die from the disease.

Heart Attacks. The use of beta blockers after heart attack has been shown to reduce mortality by 43 percent. Yet, in a sample of Medicare patients in New Jersey, only 21 percent of eligible patients received beta blockers (Soumerai, et al., 1997). Dr. Mark Chassin at the Mount Sinai School of Medicine has estimated that more consistent use of beta-blocker therapy could prevent an estimated 18,000 deaths each year (Chassin, 1997). The use of aspirin after heart attacks has also been shown to reduce mortality. But, in one study, a third of Medicare patients who survived a heart attack failed to receive aspirin within 2 days of hospitalization.

2. A major component of primary health care delivery systems is the identification, collection, analysis, interpretation, and dissemination of data. Data are necessary to effectively carry out the planning, management, direction, and evaluation of health care programs. All too often, however, this component receives a low level of attention due to the demands required for providing adequate health care services in a particular area. The focus of primary health care is to have available those resources - medical and support staff, supplies and equipment, pharmaceuticals, transportation - needed to address the health needs of the population. With these items representing major operational needs of the system and often requiring constant attention in order to carry out programs of the health care delivery system, the role of a health database or information system is often not adequately emphasized or fully integrated into the health care system. The collection of data and the use of that data are, however, essential elements of a health care delivery system. Health need of the population must be defined for data collection to take place and, once obtained, the data must be used in order to realize the benefits within the program. Otherwise efforts to provide health care may result in a significant waste of staff time, resources and funds. Where data are not collected, or collected and not used in an operational health care program, it may be that the value of the data are not recognized or that resources such as technical staff and equipment are not available to analyze or interpret the data.

Pre-existing administrative record systems can also serve as a valuable data resource to the system. Historical records relating to prior censuses can provide basic demographics of the population; inventories of drugs and other medical supplies can reflect in part the health conditions and problems of an area; documentation required to obtain employment and school records can provide data on family structure and households; and, other required reporting or registration that may exist for a variety of reasons can represent valuable input to the knowledge base for the health care system. Sample surveys, whether to determine population characteristics or health status, are an essential component of the data collection plan. Though this activity requires field work, a properly designed sample and a plan for the logistics in conducting the survey can be cost effective and produce relevant and timely data. Sampling plans may be narrowly focused or broad-based in terms of content, geographic coverage, or population; may serve to develop baseline data, provide ongoing input to the health care system, or provide an evaluation process for programs of the system; and, may be 'used to maintain a continuous health surveillance or monitoring system in support of the health care delivery programs.

Health care's structure and incentives are technology and procedure driven and do not support time for the inquiry and reflection, communication, and external relationship building typically needed for effective disease prevention and health promotion. State health departments often have legal authority to regulate the entry of providers and purchasers of health care into the market and to set insurance reimbursement rates for public and, less often, private providers and purchasers. They may control the ability of providers to acquire desired technology and perform complex, costly procedures that are important to the hospital but increase demands on state revenues. Finally, virtually all states have the legal responsibility to monitor the quality of health services provided in the public and private sectors. Many health care providers argue that such regulation adds to their costs, and high-profile problems can create additional tensions that impede collaboration between the state public health agency and the health care delivery system.

Big data and the use of advanced analytics have the potential to advance the way in which providers leverage technology to make informed clinical decisions. However, the vast amounts of information generated annually within health care must be organized and compartmentalized to enable universal accessibility and transparency between health care organizations.

Our systematic literature review revealed both challenges and opportunities that big data offers to the health care industry. The literature mentioned the challenges of data structure and security in at least 50% of the articles reviewed. The literature also mentioned the opportunities of increased quality, better management of population health, early detection of disease, and data quality structure and accessibility in at least 50% of the articles reviewed. These findings identify foci for future research.