1. MR. MARC ONEEL C. ALVAREZ, RN, RM, MAN Mr. Marc Oneel C. Alvarez, RN, RM, MAN

3.  CLINICAL EFFECTIVENESS  Appropriate use of CLINICAL RESOURCES: TESTS and TREATMENT  Guide question: 1. Are the test accurate? 2. Are the resources used appropriately? 3. What is the impact of testing information? 4. What is the diagnostic ability of the tests? INDICATORS OF TEST PERFORMANCE ACCURACY- condition of being true, correct or exact EFFICACY - is the capacity of producing a desired result or effect (effectiveness) EFFICIENCY – is the ability to accomplish a job with a minimum expenditure of time and effort. Mr. Marc Oneel C. Alvarez, RN, RM, MAN

4.  Constructs that measures the ACCURACY OF A TEST.  Quantified by the parameters known as sensitivity, specificity and predictive values Test Results Disease (D)No Disease (NoD) Totals T+ a TP b FP a + b T- c FN D TN c + d Totals a + cb + da + b + c + d Mr. Marc Oneel C. Alvarez, RN, RM, MAN

5.  Sensitivity = a/(a+c)  Specificity = d/(b+d)  Predicitive Value + = a(a + b) Test Results Disease (D)No Disease (NoD) Totals T+ a TP b FP a + b T- c FN D TN c + d Totals a + cb + da + b + c + d Mr. Marc Oneel C. Alvarez, RN, RM, MAN

6. TESTDescription SENSITIVITY a/(a+c)  ability of a test to correctly identify individuals who have a disease.  Ratio of TRUE POSITIVES to the Individuals WITH THE DISEASE  TEST FOR ACCURACY SPECIFICITY d/(b+d)  Ratio of TRUE NEGATIVES to the Individuals WITHOUT THE DISEASE  measures the number of individuals without the disease that test correctly identifies as NEGATIVE for the disease  TEST FOR ACCURACY Sensitivity and Specificity are test for accuracy. Absolute Value range from 0 to 1. The nearer the value to 1 means the test is more ACCURATE Test ResultsDisease (D)No Disease (NoD)Totals T+ a TP b FP a + b T- c FN D TN c + d Totals a + cb + da + b + c + d Mr. Marc Oneel C. Alvarez, RN, RM, MAN

7. TESTDescription PREDICTIVE VALUE OF A (+) Test Result a/(a+b)  Measures the Number of individuals with a POSITIVE TEST result who actually have the disease PREDICTIVE VALUE OF A (-) Test Result d/(c+d)  Measures the proportion of test negatives that were correctly identified by the test as NOT having the disease Test ResultsDisease (D)No Disease (NoD)Totals T+ a TP b FP a + b T- c FN D TN c + d Totals a + cb + da + b + c + d a.) Increase in Prevalence of the Disease = Increase in the Positive Predictive Value and Decrease in the Negative Predictive Value b.) Decrease in Prevalence of the Disease = Decrease in the Positive Predictive Value and Increase in the Negative Predictive Value Mr. Marc Oneel C. Alvarez, RN, RM, MAN

8. Test ResultsARTHRITISNO ARTHRITISTotals T+264180 444 T-13634203556 Totals 4003, 6004000 SENSITIVITY SPECIFICITY PREDICTIVE VALUE (+) PREDICTIVE VALUE (-) Mr. Marc Oneel C. Alvarez, RN, RM, MAN

9. Test ResultsCOLORECTAL CA NO COLORECTAL CA Totals T+1899 117 T-218811883 Totals 201,9802000 SENSITIVITY SPECIFICITY PREDICTIVE VALUE (+) PREDICTIVE VALUE (-) Mr. Marc Oneel C. Alvarez, RN, RM, MAN

10. Predictive Validity of a PREADMISSION SCREENING TEST  Test whether pre-admission screening test to Home care is accurate Test ResultsCOLORECTAL CA NO COLORECTAL CA Totals T+ ( Eligible for admission) AB A+B T- ( Not Eligible for admission) CDC+D Totals A+CB+DA+B+C+D Mr. Marc Oneel C. Alvarez, RN, RM, MAN

11.  Degree to which repeated observations result in similar result on the same individual, under the same conditions.  Often referred to as PRECISION, REPRODUCIBILITY, REPEATABILITY  Important in diagnostic and therapeutic testing  Causes of VARIATIONS: a. IMPROPER CALIBRATION OF MEASURING INSTRUMENTS b. Observer-based variation c. Temporal changes in the subject/person (BP)  RELIABILITY INDEX - used to identify Level of acceptable Variation Observer 1T + Observer 2T - Observer 2Totals T+ ab a + b T- cDc + d Totals a + cb + da + b + c + d Mr. Marc Oneel C. Alvarez, RN, RM, MAN

12. Observer 1T + Observer 2T - Observer 2Totals T+ 252045 T-18137155 Totals 43157200 RELIABILITY = (a+d) / (a+b+c+d) Mr. Marc Oneel C. Alvarez, RN, RM, MAN

13. DISEASE management Specific program of care Measuring clinical otcome Mr. Marc Oneel C. Alvarez, RN, RM, MAN

14.  CONTRACTED CARVE-OUT > provision of care to the client by contracting with Disease Management Companies  PRIMARY CARE MODEL > focuses on specialized teamwork within HMO’s and other comprehensive health care systems that assist primary care providers in caring for chronically ill patients. Mr. Marc Oneel C. Alvarez, RN, RM, MAN

15. Patients to Patients Between Patient and Health Care workers Between Healthcare workers Nosocomial Infection Mr. Marc Oneel C. Alvarez, RN, RM, MAN

16. Pathogenicity  Ability of the infectious agent to cause DETECTABLE disease = Total persons with Clinical Disease x 100 Total Infected Individuals Infectivity  Ability of the Infectious Agent to invade and multiply in a host  The minimum number of Infectious Agents in half of the group of Individual hosts Virulence  Severity of infection and can be defined as the proportion of cases of clinical diseases that result in severe disease r death  AKA as Case Fatality Rate = Total Death of the Disease Total infected individuals Mr. Marc Oneel C. Alvarez, RN, RM, MAN

17. ATTACK RATE  Coincides with the generation time (acquisition of the agent up to its max. time of communicability) = Number of new cases or condition (during the epidemic period) TOTAL Susceptible persons (during epidemic period) SECONDARY ATTACK RATE  Number of new cases of a disease or condition that develop after the epidemic has ended YET are related to the EPIDeMIC Mr. Marc Oneel C. Alvarez, RN, RM, MAN