Feb 07, 2017
Disability ( Health Burden ) ( Measure of Morbidity = Disease Burden)Methodology & DemographyPhysician - Epidemiologist / Khaled M. AlmazAssistant lecturer, Community Medicine Department,Aswan University hospital, Aswan, EgyptMaster Degree in Public Health , October 2011Master Degree in Internal Medicine , April 2015
Identify pattern of Food IntakeIndirect Methods for Nutrition AssessmentNutrition Assessment at the National LevelNational Food Consumption and Food Balance Sheet. Vital statistics Assessment of the Ecological factors.
= Vital statistics .. :- , , .
Vital statisticsIndirect indicators : for the nutritional status of the community :Mortality rate : - Infant mortality, neonatal mortality, still birth, per-natal mortality rates. - Child ( = under five mortality rates ).Morbidity statistics : Life expectancy (Survival Rate) (Disease Burden).Morbidity statistics : Incidence rate - Prevalence rate.
Classification for estimating Mortality and DisabilityDeaths were classified using a tree structure, in which the first level of disaggregation comprises three broad cause categories of diseases :-Group I: communicable diseases, perinatal, and nutritional conditions;Group II: non-communicable diseases;Group III: injuries.
Morbidity statistics to assess the frequency of the disease
Incidence rate.Prevalence rate.Disease burden.
Morbidity statistics : Incidence rate - Prevalence rate Incidence rate : new cases of Nutritional Diseases ( Over Nutrition / or / Under-Nutrition = Deficiency ).Prevalence rate : new + old : all cases of Nutritional Diseases ( Over Nutrition / or / Under-Nutrition = Deficiency ).
(service statistics derived from hospitals) e.g. protein energy malnutrition among (marasmus- kwashiorkor), Rickets among hospital attendants.iron deficiency anemia among hospital attendants.keratomalacia among hospital attendants.
A. Instruments used to measure functional abilityThe Index of Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL)If the person could do the 6 basic activities of ADL without difficulty or help from another person, he was considered non disabled in ADL activities.If the person could do one or more of the 6 activities of ADL with difficulty, he was considered having mild-moderate disability.If the person could not do one or more of the 6 activities of ADL except with help from another person, he was considered having severe ADL disability.
B. Techniques used to measure functional ability1- Direct observation is rarely used because it is so time consuming. 2- Direct tests of functioning, such as range of limb movement, walking time or standards such as joint pain scores and erythrocyte sedimentation rate, while objective may not necessarily give an accurate indication of ability or performance.3- Interview with the person concerned Most measures of functional disability are self-report methods. Respondents are asked to report limitations on their activities. The main criticism of this type of measure is subjectivity.
C . Methods for Quantifying Disability
1- Direct Methods2- Indirect Methods
1- Direct methods
Cross sectional studyCross sectional census and surveys which measure prevalence in a given period, this may be relevant for defining the extent and demographic pattern of disabilities in a population and thus indicating the need for rehabilitative services.
Longitudinal / Cohort study To measure the incidence rates or trend of disability in a given population longitudinal studies are needed.
Disability in Community ..Cross-sectional studies have demonstrated that with an increasing number of chronic diseases there is a stepwise increase in disability in ADLs, IADLs and mobility.
2. Indirect methods:Indirect methods is used for ranked the disease as a cause of disability. So, it used to apply primary preventive measures against diseases accused to have higher score in doing disability.Disability-Adjusted Life Years (DALYs): The DALYs for a given disease condition are the sum of years of life lost due to premature mortality and the number of years of life lived with disability- adjusted to the severity of disability.Healthy Life Years (Heal Y): Healthy life years (Heal Y) lost as a result of premature mortality and disability is a composite indicator that incorporates mortality and morbidity into a single number.Both DALYs and Heal Y are measuring disease burden on disability.
Life expectancy (Survival Rate)---------------Morbidity statistics : To assess the frequency of the diseaseDisease Burden( years of potential life lost )DALYs : Disability-adjusted life year QALYs : Quality-adjusted life years
Types of Disease BurdenDALYsQALYsHALE
Indicators of HealthDisability Indicators: Sullivan's index , HALE (Health Adjusted Life Expectancy) , DALY (Disability Adjusted Life Year).===============Sullivan's index is a expectation of life free from disability.HALE is the equivalent number of years in full health that a newborn can expected to live based on the current rates of ill health and mortality. DALY expresses the years of life lost to premature death and years lived with disability adjusted for the severity of disability.
Health ExpectanciesHealth expectancies measure years of life gained or years of improved quality of life. In this group of measures, among others, Following Measures are classified:Active life expectancy (ALE),Disability-free life expectancy (DFLE),Disability-adjusted life expectancy (DALE),Healthy adjusted life expectancy (HALE),Quality adjusted life expectancy (QALE).
Health GapsHealth gaps measure lost years of full health in comparison with some ideal health status or accepted standard. In this group of measures among others,Following Measures (indicators) are classified:Potential years of life lost (PYLL),Healthy years of life lost (HYLL),Quality adjusted life years (QALY),Disability adjusted life years (DALY).
Both approaches use Time and multiply number of years lived (or, not lived in case of premature death) by the quality of those years. The process of adjustment of the years of healthy life lived is called quality adjustment (expressed as QALYs) The process of adjustment of the years of healthy life lost is called disability adjustment (expressed as DALYs) .
It means that QALYs represent a gain which should be maximized, DALYs represent a loss which should be minimized. In the QALY approach the quality is weighted (sometimes called utility, as it is the case of cost-utility analyses) on a Scale from 1 indicating perfect health and the highest quality of life, to 0 indicating no quality of life and is synonymous to death.
In the DALY approach the Scale goes in opposite way: a Disability weighted zero indicates perfect health (no disability), and weighted 1 indicates death.
The Disability weighting is the most difficult and controversial part of the DALY approach .
Calculation of DALYsDisability-Adjusted Life Year (DALY) conceptThe DALY measure is the sum of both dimensions / components just described :-The Sum of the YLLs and the YLDs (4,10,11,15-19) :DALY = YLL + YLDDALY = disability adjusted life yearsYLL = years of life lost due to premature deathYLD = years lost due to disability
Calculating DALYs.At the end the YLLs and the YLDs are summed up according to Equation 4.The sum of the YLLs and the YLDs (4,10,11,15-19) :DALY = YLL + YLDFor the woman from Example 8 the DALYs are calculated as follows:DALY = 33.99 + 10.50 = 44.49The burden of disease in this case in terms of DALYs is 44.49 years.
Quality Assurance of Medical Practice
QUALITY OF HEALTH CARE
What is Quality?The quality of technical care consists in the application of medical science and technology in a manner that maximizes its benefit to health without correspondingly increasing risks. The most comprehensive and perhaps the simplest definition of quality is that used by advocates of Total Quality Management: Do the right thing, right, the first time.
Components of Quality1.Effectiveness2.Efficiency3.Technical ~2ornpeence4.SafetyS.Accessibility6.Interpersonal Relations7.Continuity8.Amenities
Effectiveness: doing "right" things, i.e. setting right targets to achieve an overall goal
Efficiency: doing things in the most economical way (good input to output ratio)
Cost EffectivenessCost-effectiveness analysis (CEA) is a form of Economic Analysis that compares the Relative Costs and Outcomes (Effects) of different courses of action. Cost-effectiveness analysis is distinct from costbenefit analysis, which assigns a monetary value to the Measure of Effect.The most commonly used Outcome Measure is Quality-Adjusted Life Years (QALY).A special case of CEA is CostUtility Analysis , where the Measure of Effect in terms of years of full health lived, using a measure :Quality-Adjusted Life Years. Disability-Adjusted Life Years.
Cost-Effectiveness is typically expressed as an incremental cost-effectiveness ratio (ICER), the ratio of change in costs to the change in effects. A complete compilation of Cost-Utility Analyses in the peer reviewed medical literature is available from the Cost-Effectiveness Analysis Registry website.
CEA () . . . ( ) . QALY .. . .
Cost Efficiency (Cost Optimality)In the context of Parallel Computer Algorithms, refers to a Measure of how Effectively Parallel Computing can be used to solve a particular problem. A