COVER
TITLE PAGE
LIST OF TABLES, FIGURES, AND EXHIBITS
PREFACE
THE AUTHORS
CHAPTER ONE: EPIDEMIOLOGY IN HEALTH CARE ADMINISTRATION
1. Introduction
2. Philosophical Framework
3. Focus and Uses of Epidemiology
4. Health Care Reform
5. The Concept of Populations and Communities
6. Managing Health Care for Populations and Communities
7. Role of Epidemiology
8. Summary
9. Study Questions
CHAPTER TWO: DESCRIPTION OF HEALTH
1. Introduction
2. Health and Disease
3. Descriptive Information
4. Other Descriptive Variables
5. Sources of Descriptive Information
6. Reportable Diseases
7. Managerial Applications
8. Summary
9. Study Questions
CHAPTER THREE: MEASUREMENT OF HEALTH
1. Introduction
2. Measures
3. Measuring Morbidity
4. Measuring Mortality
5. Measuring Health
6. Other Rates
7. Summary
8. Study Questions
CHAPTER FOUR: STUDYING THE HEALTH NEEDS OF POPULATIONS
1. Introduction
2. Risk and Causation
3. Study Designs
4. Association of Risk Factors and Health and Disease
5. Measuring Association in Prospective Studies
6. Measuring Association in Retrospective Studies
7. Application to Population Health Management
8. Sampling
9. Summary
10. Study Questions
CHAPTER FIVE: STANDARDIZING POPULATION HEALTH INFORMATION
1. Introduction
2. Stratification
3. Matching
4. Standardization of Information
5. Risk Adjustment
6. Summary
7. Study Questions
CHAPTER SIX: MEDICAL MANAGEMENT IN POPULATION HEALTH CARE
1. Introduction
2. Medical Management
3. Chronic Disease Management
4. Summary
5. Study Questions
CHAPTER SEVEN: MANAGEMENT OF INFECTIOUS EPIDEMICS
1. Introduction
2. Infectious Disease Epidemiology
3. Health Care–Associated Infections
4. Surveillance
5. Summary
6. Study Questions
CHAPTER EIGHT: REIMBURSEMENT APPROACHES AND MARKETING
1. Introduction
2. Reimbursement Methods
3. Marketing and Population Health
4. Market Research
5. Summary
6. Study Questions
CHAPTER NINE: POPULATION HEALTH OUTCOMES AND QUALITY OF CARE
1. Introduction
2. Assessing Health Outcomes
3. Health Status Assessment
4. Patient Satisfaction and Patient Expectations Assessment
5. Monitoring Health Outcomes
6. Managing with Health Outcomes
7. Quality of Health Care
8. Summary
9. Study Questions
CHAPTER TEN: ECONOMIC ANALYSIS OF HEALTH CARE FOR POPULATIONS
1. Introduction
2. Economic Evaluation
3. Cost Analysis
4. Cost‐Benefit Analysis
5. Cost‐Effectiveness Analysis
6. Cost‐Utility Analysis
7. Discounting
8. Sensitivity Analysis
9. Burden of Disease Analysis
10. Examples of Economic Analysis
11. Summary
12. Study Questions
CHAPTER ELEVEN: EXPANDING HOSPITAL HEALTH CARE SERVICES
1. Introduction
2. Service Area Population
3. Hospital Care Utilization
4. Discharges
5. Length of Hospital Stay
6. Hospital Description
7. Payment Sources
8. Service Area Population Health
CHAPTER TWELVE: LONG‐TERM CARE
1. Introduction
2. Population Characteristics
3. Westside Elderly Care, Inc
4. Utilization of Services
5. Staffing
CHAPTER THIRTEEN: EMERGENCY DEPARTMENT SERVICES
1. Introduction
2. Emergency Department Utilization
3. Payment Sources
4. Time Analysis
5. Primary Diagnosis at Arrival
6. Patient Disposition
CHAPTER FOURTEEN: PHYSICIAN PRACTICES
1. Introduction
2. Population Characteristics
3. Resource Utilization
4. Time Since Last Visit
5. Insurance Coverage
6. Reason for Visit
7. Preventive Care Visits
8. Chronic Conditions
REFERENCES
INDEX
END USER LICENSE AGREEMENT

List of Tables

Chapter 2
1. TABLE 2.1. NUMBER, PERCENT DISTRIBUTION, AND RATE OF INJURY‐RELATED EMERGENCY DEPARTMENT VISITS, BY AGE, 2011
2. TABLE 2.2. PERCENT OF PERSONS LACKING HEALTH INSURANCE, STATES WITH STATE‐BASED MARKETPLACE, 18 TO 64 YEARS OF AGE, 2010–2016
3. TABLE 2.3. CANCER DEATH RATES, BY AGE, UNITED STATES, 2013
4. TABLE 2.4. TUBERCULOSIS CASES, BY AGE, UNITED STATES, 2013
5. TABLE 2.5. DEATHS, BY SEX, UNITED STATES, 2014
6. TABLE 2.6. NUMBER, PERCENT DISTRIBUTION, AND RATE OF INJURY‐RELATED EMERGENCY DEPARTMENT VISITS, BY AGE AND SEX, 2011
7. TABLE 2.7. EMERGENCY DEPARTMENT VISITS, BY RACE, UNITED STATES, 2011
8. TABLE 2.8. FREQUENCY OF CANCER DEATHS, BY RACE AND CANCER SITE, PER 100,000 POPULATION, UNITED STATES, 2013
9. TABLE 2.9. FREQUENCY OF NEW CANCER CASES, BY RACE AND CANCER SITE, PER 100,000 POPULATION, UNITED STATES, 2013
10. TABLE 2.10. CHRONIC DISEASE RISK FACTORS AND MARITAL STATUS, 2010
11. TABLE 2.11. PERCENTAGE OF UNINSURED PERSONS UNDER 65 YEARS OF AGE AND POVERTY STATUS, UNITED STATES, 2005–2016
12. TABLE 2.12. PERCENTAGE OF PERSONS LACKING HEALTH INSURANCE COVERAGE, BY EDUCATIONAL STATUS, UNITED STATES, 2015
13. TABLE 2.13. INPATIENT DISCHARGES FROM SHORT‐STAY HOSPITALS, BY REGION, UNITED STATES, 2010
14. TABLE 2.14. EMERGENCY DEPARTMENT VISITS, BY SEASON OF THE YEAR, UNITED STATES, 2011
15. TABLE 2.15. INPATIENT DEATHS, PER 100 PERSONS HOSPITALIZED FOR DIAGNOSIS, BY FIRST‐LISTED DIAGNOSIS, UNITED STATES, 2000, 2005, 2010
16. TABLE 2.16. NUMBER AND PERCENT OF EMERGENCY DEPARTMENT VISITS, BY SOURCE OF PAYMENT, UNITED STATES, 2011
17. TABLE 2.17. NOTIFIABLE DISEASES, UNITED STATES, 2016
Chapter 3
1. TABLE 3.1. CASES OF AIDS, BY STATE, UNITED STATES, 2013
2. TABLE 3.2. TOP TEN STATES BY NUMBER OF NEW HIV DIAGNOSES, UNITED STATES, 2014
3. TABLE 3.3. HIV CASE RATE PER 100,000 POPULATION, UNITED STATES, 2012
4. TABLE 3.4. NUMBER OF VISITS WITH A DOCTOR OR OTHER HEALTH CARE PROFESSIONAL, ADULTS 18 YEARS OF AGE AND OLDER, BY AGE, SEX, AND RACE, UNITED STATES, 2014
5. TABLE 3.5. EMERGENCY DEPARTMENT VISITS, UNITED STATES, 2011
6. TABLE 3.6. HIV CASES RATIOS, BY RACE AND TRANSMISSION, UNITED STATES, 2010–2013
7. TABLE 3.7. AGE‐ADJUSTED DIABETES PREVALENCE RATIOS, BY SEX AND EDUCATION ATTAINMENT, MISSISSIPPI, 2005–2013
8. TABLE 3.8. HOME HEALTH AND HOSPICE CARE AGENCIES, BY OWNERSHIP, GEOGRAPHIC REGION, AND LOCATION, UNITED STATES, 2014
9. TABLE 3.9. INCIDENCE RATEA OF SELECTED INFECTIOUS DISEASES, BY YEAR, UNITED STATES, 2000–2013
10. TABLE 3.10. AGE‐ADJUSTED INVASIVE CANCER INCIDENCE RATES, BY RACE, CALIFORNIA, 2013
11. TABLE 3.11. ASTHMA PREVALENCE RATE, BY RACE AND SEX, 2014
12. TABLE 3.12. PREVALENCE OF WOMEN AGED 18 AND OLDER WHO REPORTED RECEIVING A PAPANICOLAOU TEST DURING THE PAST THREE YEARS, PER 100 POPULATION, BY AGE, SELECTED STATES AND TERRITORIES, UNITED STATES, 2014
13. TABLE 3.13. PREVALENCE OF WOMEN AGED 50 AND OLDER WHO REPORTED HAVING A MAMMOGRAM DURING THE PAST TWO YEARS, PER 100 POPULATION, BY RACE, SELECTED STATES, UNITED STATES, 2014
14. TABLE 3.14. CRUDE DEATH RATE, BY SEX AND RACE, UNITED STATES, 2011–2012
15. TABLE 3.15. CAUSE‐SPECIFIC MORTALITY RATES FOR SEVERAL CAUSES OF DEATH, UNITED STATES, 2014
16. TABLE 3.16. AGE‐SPECIFIC MORTALITY RATE, MALIGNANT NEOPLASM, UNITED STATES, 2012
17. TABLE 3.17. CASE‐FATALITY RATE, BY PATHOGEN, FOODBORNE INFECTIONS, UNITED STATES, 2010
18. TABLE 3.18. INFANT MORTALITY RATE, BY RACE OF MOTHER, UNITED STATES, 1990–2012
19. TABLE 3.19. NEONATAL MORTALITY RATE, BY RACE OF MOTHER, UNITED STATES, 1990–2012
20. TABLE 3.20. POST‐NEONATAL MORTALITY RATE, BY RACE OF MOTHER, UNITED STATES, 1990–2012
21. TABLE 3.21. PROPORTIONATE MORTALITY RATIO AMONG PLUMBERS, PIPE/STEAM FITTERS, WHITE MEN, BY AGE, UNITED STATES, 1971–1995
22. TABLE 3.22. POTENTIAL YEARS OF LIFE LOST CALCULATION METHOD, USING INDIVIDUAL‐LEVEL INFORMATION
23. TABLE 3.23. POTENTIAL YEARS OF LIFE LOST CALCULATION METHOD, USING AGE GROUP INFORMATION
24. TABLE 3.24. POTENTIAL YEARS OF LIFE LOST, BEFORE AGE 75, FOR SELECTED CAUSES OF DEATH, UNITED STATES, 1990–2014
25. TABLE 3.25. MENTAL HEALTH STATUS AMONG DIABETICS, MISSISSIPPI, 2003–2013
Chapter 4
1. TABLE 4.1. CALCULATION OF RELATIVE RISK
2. TABLE 4.2. ASSOCIATION OF SMOKING AND CORONARY HEART DISEASE (CHD)—RELATIVE RISK ANALYSIS
3. TABLE 4.3. RETROSPECTIVE STUDY DESIGN 2 BY 2 TABLE
4. TABLE 4.4. ASSOCIATION BETWEEN SMOKING AND CORONARY HEART DISEASE (CHD)—PROPORTIONS ANALYSIS
5. TABLE 4.5. ODDS RATIO CALCULATION
6. TABLE 4.6. ASSOCIATION BETWEEN SMOKING AND CORONARY HEART DISEASE (CHD)—ODDS RATIO ANALYSIS
7. TABLE 4.7. BIRTHS AND CESAREAN SECTIONS IN THE STUDY POPULATION
8. TABLE 4.8. TOTAL LIVE BIRTHS AMONG MEDICAID BENEFICIARIES
9. TABLE 4.9. CESAREAN SECTION RATE AND RELATIVE RISK, BY AGE OF MOTHER
10. TABLE 4.10. CESAREAN SECTION RATES AND RELATIVE RISK, BY LOCALE
11. TABLE 4.11. MYOCARDIAL INFARCTION RATES, PER 100,000 POPULATION AND HIV STATUS
12. TABLE 4.12. RISK FACTORS FOR FALLS IN ELDERLY POPULATION
Chapter 5
1. TABLE 5.1. OUTPATIENT DEPARTMENT VISITS, BY AGE AND SEX, UNITED STATES, 2011
2. TABLE 5.2. LUNG CANCER AND ALCOHOL USE
3. TABLE 5.3. STRATIFICATION BY SMOKING STATUS
4. TABLE 5.4. STANDARDIZATION OF OUTPATIENT DEPARTMENT VISITS, BY SEX, UNITED STATES, 2011
5. TABLE 5.5. CRUDE CASE‐FATALITY RATES, BY AGE
6. TABLE 5.6. STANDARDIZED CASE‐FATALITY RATES
7. TABLE 5.7. STANDARD (COMBINED) POPULATION
8. TABLE 5.8. STANDARDIZED CASE‐FATALITY RATES USING COMBINED STANDARD POPULATION
9. TABLE 5.9. OUTPATIENT VISITS, BY AGE AND RACE, UNITED STATES, 2011
10. TABLE 5.10. INDIRECT STANDARDIZATION OF OUTPATIENT VISITS RATE
11. TABLE 5.11. SCREENING PROGRAM DATA
12. TABLE 5.12. INDIRECT STANDARDIZATION
13. TABLE 5.13. HOSPITAL STANDARDIZED MORTALITY RATIO CALCULATION
14. TABLE 5.14. SEVERITY OF ILLNESS DISTRIBUTION
15. TABLE 5.15. RECOVERY DISTRIBUTION
16. TABLE 5.16. STRATUM‐SPECIFIC RATES
17. TABLE 5.17. CRUDE RATES FOR OUTPATIENT VISITS IN THE HANCOCK REGIONAL HOSPITAL NETWORK
18. TABLE 5.18. CRUDE RATES FOR OUTPATIENT VISITS IN THE HARRISON HOSPITAL SYSTEM
19. TABLE 5.19. POPULATION DISTRIBUTION, HANCOCK REGIONAL HOSPITAL NETWORK
20. TABLE 5.20. POPULATION DISTRIBUTION, HARRISON HOSPITAL SYSTEM
21. TABLE 5.21. STANDARD POPULATION CRUDE OUTPATIENT DEPARTMENT VISIT RATES
22. TABLE 5.22. AGE‐SPECIFIC RATE AND EXPECTED CASES FOR HANCOCK REGIONAL HOSPITAL NETWORK
23. TABLE 5.23. AGE‐SPECIFIC RATE AND EXPECTED CASES FOR HARRISON HOSPITAL SYSTEM
24. TABLE 5.24. AGE‐SPECIFIC RATE AND EXPECTED CASES FOR HANCOCK REGIONAL HOSPITAL NETWORK USING COMBINED POPULATION
25. TABLE 5.25. AGE‐SPECIFIC RATE AND EXPECTED CASES FOR HARRISON HOSPITAL SYSTEM USING COMBINED POPULATION
26. TABLE 5.26. CRUDE RATE FOR MI COMPLICATIONS IN JEFFERSON COUNTY
27. TABLE 5.27. CRUDE RATE FOR MI COMPLICATIONS IN WASHINGTON COUNTY
28. TABLE 5.28. POPULATION DISTRIBUTION, JEFFERSON COUNTY
29. TABLE 5.29. POPULATION DISTRIBUTION, WASHINGTON COUNTY
30. TABLE 5.30. STANDARD POPULATION CRUDE MI COMPLICATION RATES
31. TABLE 5.31. EXPECTED MI COMPLICATIONS, JEFFERSON COUNTY
32. TABLE 5.32. EXPECTED MI COMPLICATIONS, WASHINGTON COUNTY
Chapter 6
1. TABLE 6.1. CALCULATION OF LIKELIHOOD RATIOS IN TESTS WITH DICHOTOMOUS RESULTS
2. TABLE 6.2. CALCULATION OF LIKELIHOOD RATIOS IN TESTS WITH POLYCHOTOMOUS RESULTS
3. TABLE 6.3. MAMMOGRAPHY AND PAP SMEARS RESULTS FOR FISCAL YEAR 2015–2016
4. TABLE 6.4. SCREENING TEST FOR DIABETES
Chapter 7
1. TABLE 7.1. WORLDWIDE IMPACT OF SARS, JULY 2003
2. TABLE 7.2. WEST NILE VIRUS CASES, UNITED STATES, 2016
3. TABLE 7.3. RESULTS OF GASTRITIS INVESTIGATION
Chapter 8
1. TABLE 8.1. INCIDENCE OF CVD IN THE EAST BANK REGIONAL HOSPITAL SERVICE AREA
Chapter 10
1. TABLE 10.1. COST ANALYSIS, YEAR 1
2. TABLE 10.2. PROGRAM COSTS, BY YEAR
3. TABLE 10.3. COST‐EFFECTIVENESS OF DIAGNOSTIC INTERVENTIONS
4. TABLE 10.4. BENEFITS OF COMMUNITY OUTREACH PROGRAM
5. TABLE 10.5. COST‐UTILITY ANALYSIS OF TREATMENT APPROACHES
6. TABLE 10.6. LEADING CAUSES OF DALYS, WORLDWIDE, 2000
7. TABLE 10.7. LEADING CAUSES OF DALYS, WORLDWIDE, 2012
8. TABLE 10.8. LEADING CAUSES OF DEATH, WORLDWIDE, 1990 AND 2020
9. TABLE 10.9. COSTS OF INITIATIVES, SIX‐MONTH PERIOD
Chapter 11
1. TABLE 11.1. POPULATION CHARACTERISTICS, BY AGE
2. TABLE 11.2. PERSONS WITH ONE HOSPITAL STAY IN THE PAST YEAR, BY AGE, SEX, AND RACE, PERCENT, 1999–2016
3. TABLE 11.3. PERSONS WITH TWO OR MORE HOSPITAL STAYS IN THE PAST YEAR, BY AGE, SEX, AND RACE, PERCENT, 1999–2016
4. TABLE 11.4. DISCHARGES, BY AGE AND SEX, 2014–2016
5. TABLE 11.5. DISCHARGES WITH AT LEAST ONE PROCEDURE, 2011, 2016
6. TABLE 11.6. DISCHARGES WITH AT LEAST ONE PROCEDURE, BY AGE, 2011
7. TABLE 11.7. DISCHARGES WITH AT LEAST ONE PROCEDURE, BY AGE, 2016
8. TABLE 11.8. AVERAGE LENGTH OF STAY, BY AGE AND SEX, 2014–2016
9. TABLE 11.9. PERCENT OCCUPANCY RATE, BY HOSPITAL, 2014–2016
10. TABLE 11.10. EAST BANK HOSPITAL SYSTEM SERVICE AREA INSURANCE COVERAGE, PERSONS UNDER 65, PERCENT, BY AGE, SEX, AND RACE
11. TABLE 11.11. MEDICAID COVERAGE IN THE EAST BANK HOSPITAL SYSTEM SERVICE AREA, BY AGE, SEX, AND RACE, 2014–2016
12. TABLE 11.12. MEDICARE COVERAGE IN THE EAST BANK HOSPITAL SERVICE AREA, BY AGE, SEX, AND RACE, 2011, 2016
13. TABLE 11.13. EAST BANK HOSPITAL SYSTEM SERVICE AREA CANCER INCIDENCE RATES, PER 100,000 POPULATION, BY RACE AND SEX
14. TABLE 11.14. EAST BANK HOSPITAL SYSTEM SERVICE AREA PREVALENCE OF HEART DISEASE, CANCER, AND STROKE, PERCENT, 2016
15. TABLE 11.15. EAST BANK HOSPITAL SYSTEM SERVICE AREA PREVALENCE OF DIABETES AND POOR GLYCEMIC CONTROL, BY AGE, SEX, RACE, AND POVERTY LEVEL, PERCENT, 2016
16. TABLE 11.16. CHRONIC DISEASES IN THE EAST BANK HOSPITAL SYSTEM SERVICE AREA, BY AGE, SEX, RACE, AND INSURANCE COVERAGE, PERCENT, 2016
Chapter 12
1. TABLE 12.1. POPULATION, EAST BANK COUNTY
2. TABLE 12.2. POPULATION, LAKESHORE COUNTY
3. TABLE 12.3. USERS OF LONG‐TERM CARE SERVICES, LAKESHORE COUNTY
4. TABLE 12.4. USERS OF LONG‐TERM CARE SERVICES, EAST BANK COUNTY
5. TABLE 12.5. USAGE RATE OF LONG‐TERM CARE SERVICES, PER 1,000 PERSONS 65 YEARS AND OLDER, BY AGE, LAKESHORE COUNTY AND WEC‐LC
6. TABLE 12.6. USAGE RATE OF LONG‐TERM CARE SERVICES, PER 1,000 PERSONS 65 YEARS AND OLDER, BY AGE, EAST BANK COUNTY AND WEC‐EB
7. TABLE 12.7. CURRENT LONG‐TERM CARE STAFFING, LAKESHORE COUNTY
8. TABLE 12.8. CURRENT LONG‐TERM CARE STAFFING, EAST BANK COUNTY
Chapter 13
1. TABLE 13.1. EMERGENCY DEPARTMENT VISITS, BY AGE
2. TABLE 13.2. EMERGENCY DEPARTMENT VISITS, BY AGE AND SEX
3. TABLE 13.3. EMERGENCY DEPARTMENT VISITS, BY AGE AND RACE
4. TABLE 13.4. INJURY VISITS TO THE EMERGENCY DEPARTMENT, BY AGE AND SEX
5. TABLE 13.5. INJURY VISITS TO THE EMERGENCY DEPARTMENT, BY AGE AND RACE
6. TABLE 13.6. PRIMARY PAYMENT SOURCE
7. TABLE 13.7. WAIT TIME AND TIME SPENT IN EMERGENCY DEPARTMENT
8. TABLE 13.8. LEADING PRIMARY DIAGNOSIS GROUPS AT ARRIVAL
9. TABLE 13.9. DISPOSITION OF EMERGENCY DEPARTMENT VISITS
10. TABLE 13.10. VISITS RESULTING IN HOSPITAL ADMISSION
11. TABLE 13.11. LEADING PRINCIPAL HOSPITAL DISCHARGE DIAGNOSIS GROUPS FOR EMERGENCY DEPARTMENT VISITS
Chapter 14
1. TABLE 14.1. AGE DISTRIBUTION OF ADULT POPULATION, EAST BANK CITY, 2016
2. TABLE 14.2. CRESCENT DOCTORS, LTD., PATIENT POPULATION, BY AGE AND SEX, 2011 AND 2016
3. TABLE 14.3. CRESCENT DOCTORS, LTD., PATIENT POPULATION, BY AGE AND RACE, 2011 AND 2016
4. TABLE 14.4. PERCENT DISTRIBUTION LENGTH OF TIME SINCE LAST VISIT, ADULT PATIENTS, 2016
5. TABLE 14.5. PERCENT INSURANCE COVERAGE, ADULTS UNDER 65 YEARS OF AGE, 2016
6. TABLE 14.6. PERCENT INSURANCE COVERAGE, ADULTS OVER 65 YEARS OF AGE, 2016
7. TABLE 14.7. PERCENT DISTRIBUTION MAJOR REASON FOR OFFICE VISIT, BY AGE, 2011 AND 2016
8. TABLE 14.8. PERCENT DISTRIBUTION MAJOR REASON FOR OFFICE VISIT, BY SEX AND RACE, 2011 AND 2016
9. TABLE 14.9. PREVENTIVE CARE VISITS, BY AGE, SEX, AND RACE, 2016
10. TABLE 14.10. PRESENCE OF SELECTED CHRONIC CONDITIONS, PERCENT DISTRIBUTION, BY AGE, 2016
11. TABLE 14.11. PRESENCE OF SELECTED CHRONIC CONDITIONS, PERCENT DISTRIBUTION, BY SEX, 2016

List of Illustrations

Chapter 1
1. FIGURE 1.1. EPIDEMIOLOGIC DATA
Chapter 2
1. FIGURE 2.1. POPULATION PYRAMID, UNITED STATES, 2016
2. FIGURE 2.2. FOODBORNE OUTBREAK
Chapter 3
1. FIGURE 3.1. INCIDENCE RATE OF READMISSIONS
Chapter 4
1. FIGURE 4.1. A 2 BY 2 CONTINGENCY TABLE
2. FIGURE 4.2. EXPERIMENTAL STUDY DESIGNS
3. FIGURE 4.3. FRAMEWORK OF RANDOMIZED CONTROLLED CLINICAL TRIALS
4. FIGURE 4.4. OBSERVATIONAL STUDY DESIGNS
Chapter 5
1. FIGURE 5.1. DIRECT METHOD OF STANDARDIZATION
2. FIGURE 5.2. INDIRECT METHOD OF STANDARDIZATION
Chapter 6
1. FIGURE 6.1. VALIDITY 2 BY 2 CONTINGENCY TABLE
2. FIGURE 6.5. PREDICTIVE VALIDITY OF PREADMISSION SCREENING TEST
3. FIGURE 6.6. RELIABILITY INDEX
4. FIGURE 6.7. RELIABILITY INDEX CALCULATION
5. FIGURE 6.8. LIKELIHOOD RATIOS
6. FIGURE 6.9. ROC CURVE (THE DIAGONAL LINE REPRESENTS CHANCE; AN ROC THAT IS WELL ABOVE THE DIAGONAL LINE INDICATES AN ACCURATE TEST)
Chapter 7
1. FIGURE 7.1. COMMON‐SOURCE OUTBREAK
2. FIGURE 7.2. PROPAGATED EPIDEMIC
Chapter 8
1. FIGURE 8.1. RVU CALCULATION
Chapter 9
1. FIGURE 9.1. PATIENT SATISFACTION CONTROL CHART
2. FIGURE 9.2. CONTROL CHART FOR PATIENT FALLS
3. FIGURE 9.3. QUALITY CONTROL CHART
Chapter 10
1. FIGURE 10.1. OUTCOMES OF ECONOMIC EVALUATIONS
2. FIGURE 10.2. PRESENT VALUE OF COMMUNITY OUTREACH PROGRAM
3. FIGURE 10.3. PRESENT VALUE OF IN‐HOSPITAL PROGRAM
4. FIGURE 10.4. DISCOUNTED BENEFITS OF COMMUNITY OUTREACH PROGRAM
5. FIGURE 10.5. DISCOUNTED BENEFITS OF IN‐HOSPITAL PROGRAM
6. FIGURE 10.6. COST‐EFFECTIVENESS RATIO
Chapter 11
1. FIGURE 11.1. SERVICE AREA POPULATION, PERCENT DISTRIBUTION
2. FIGURE 11.2. PERCENT OF PATIENTS WITH ONE HOSPITAL STAY, 1999–2016, BY AGE
3. FIGURE 11.3. PERCENT OF PATIENTS WITH TWO OR MORE HOSPITAL STAYS, 1999–2016, BY AGE
4. FIGURE 11.4. DISCHARGES BY SEX, PER 10,000 POPULATION, 2014–2016
5. FIGURE 11.5. AVERAGE LENGTH OF STAY, BY AGE, 2014–2016
6. FIGURE 11.6. OCCUPANCY RATE, PERCENT, BY HOSPITAL, 2014–2016
7. FIGURE 11.7. PREVALENCE OF DIABETES AND POOR GLYCEMIC CONTROL, 2016
Chapter 12
1. FIGURE 12.1. POPULATION CHARACTERISTICS, BY RACE, EAST BANK COUNTY
2. FIGURE 12.2. POPULATION CHARACTERISTICS, BY AGE, EAST BANK COUNTY
3. FIGURE 12.3. POPULATION CHARACTERISTICS, BY RACE, LAKESHORE COUNTY
4. FIGURE 12.4. POPULATION CHARACTERISTICS, BY AGE, LAKESHORE COUNTY
5. FIGURE 12.5. NUMBER OF USERS OF LONG‐TERM CARE SERVICES, LAKESHORE COUNTY
6. FIGURE 12.6. NUMBER OF USERS OF LONG‐TERM CARE SERVICES, EAST BANK COUNTY
7. FIGURE 12.7. PERCENT USERS OF ADULT DAY CARE, BY AGE, LAKESHORE COUNTY
8. FIGURE 12.8. PERCENT USERS OF ADULT DAY CARE, BY AGE, EAST BANK COUNTY
9. FIGURE 12.9. PERCENT USERS OF HOME HEALTH SERVICES, BY AGE, LAKESHORE COUNTY
10. FIGURE 12.10. PERCENT USERS OF HOME HEALTH SERVICES, BY AGE, EAST BANK COUNTY
11. FIGURE 12.11. PERCENT USERS OF HOSPICE SERVICES, BY AGE, LAKESHORE COUNTY
12. FIGURE 12.12. PERCENT USERS OF HOSPICE SERVICES, BY AGE, EAST BANK COUNTY
13. FIGURE 12.13. PERCENT USERS OF NURSING SERVICES, BY AGE, LAKESHORE COUNTY
14. FIGURE 12.14. PERCENT USERS OF NURSING SERVICES, BY AGE, EAST BANK COUNTY
15. FIGURE 12.15. PERCENT USERS OF RESIDENTIAL CARE COMMUNITY, BY AGE, LAKESHORE COUNTY
16. FIGURE 12.16. PERCENT USERS OF RESIDENTIAL CARE COMMUNITY, BY AGE, EAST BANK COUNTY
17. FIGURE 12.17. USAGE RATE OF LONG‐TERM CARE SERVICES AMONG PERSONS 65 YEARS AND OLDER, PER 1,000 PEOPLE 65 YEARS AND OLDER, BY AGE, LAKESHORE COUNTY AND WEC‐LC
18. FIGURE 12.18. USAGE RATE OF LONG‐TERM CARE SERVICES AMONG PERSONS 65 YEARS AND OLDER, PER 1,000 PEOPLE 65 YEARS AND OLDER, BY AGE, EAST BANK COUNTY AND WEC‐EB
19. FIGURE 12.19. USAGE RATE OF LONG‐TERM CARE SERVICES AMONG PERSONS 85 YEARS AND OLDER, PER 1,000 PEOPLE 65 YEARS AND OLDER, BY AGE, LAKESHORE COUNTY AND WEC‐LC
20. FIGURE 12.20. USAGE RATE OF LONG‐TERM CARE SERVICES AMONG PERSONS 85 YEARS AND OLDER, PER 1,000 PEOPLE 65 YEARS AND OLDER, BY AGE, EAST BANK COUNTY AND WEC‐EB
Chapter 13
1. FIGURE 13.1. EMERGENCY DEPARTMENT VISITS, BY AGE (VISITS IN THOUSANDS)
2. FIGURE 13.2. EMERGENCY DEPARTMENT VISITS, BY AGE AND SEX (VISITS IN THOUSANDS)
3. FIGURE 13.3. UTILIZATION RATE OF EMERGENCY DEPARTMENT VISITS, BY AGE AND SEX (PER 100 PERSONS PER YEAR)
4. FIGURE 13.4. EMERGENCY DEPARTMENT VISITS, BY AGE AND RACE (VISITS IN THOUSANDS)
5. FIGURE 13.5. UTILIZATION RATE OF EMERGENCY DEPARTMENT VISITS, BY AGE AND RACE (PER 100 PERSONS PER YEAR)
6. FIGURE 13.6. RATE OF INJURY‐RELATED EMERGENCY DEPARTMENT VISITS, BY AGE (PER 100 PERSONS PER YEAR)
7. FIGURE 13.7. RATE OF INJURY‐RELATED EMERGENCY DEPARTMENT VISITS, BY AGE AND SEX (PER 100 PERSONS PER YEAR)
8. FIGURE 13.8. RATE OF INJURY‐RELATED EMERGENCY DEPARTMENT VISITS, BY AGE AND RACE (PER 100 PERSONS PER YEAR)
9. FIGURE 13.9. PRIMARY PAYMENT SOURCE, PERCENT
10. FIGURE 13.10. WAIT TIME IN EMERGENCY DEPARTMENT, BY NUMBER OF VISITS
11. FIGURE 13.11. WAIT TIME IN EMERGENCY DEPARTMENT, PERCENT
12. FIGURE 13.12. DURATION OF EMERGENCY DEPARTMENT VISIT, BY NUMBER OF VISITS
13. FIGURE 13.13. DURATION OF EMERGENCY DEPARTMENT VISIT, PERCENT
14. FIGURE 13.14. PRIMARY DIAGNOSIS AT ARRIVAL, PERCENT, SELECTED DIAGNOSES
Chapter 14
1. FIGURE 14.1. AGE DISTRIBUTION, PERCENT
2. FIGURE 14.2. OFFICE VISITS, BY AGE, PERCENT, 2011 AND 2016
3. FIGURE 14.3. OFFICE VISITS, WHITES, PERCENT, 2011 AND 2016
4. FIGURE 14.4. OFFICE VISITS, BLACKS/AFRICAN AMERICANS, PERCENT, 2011 AND 2016
5. FIGURE 14.5. PAYMENT SOURCES, ADULTS UNDER AGE 65, PERCENT
6. FIGURE 14.6. PAYMENT SOURCES, ADULTS OVER AGE 65, PERCENT
7. FIGURE 14.7. MAJOR REASON FOR VISIT, BY AGE, 2011 AND 2016
8. FIGURE 14.8. MAJOR REASON FOR VISIT, BY SEX, 2011 AND 2016
9. FIGURE 14.9. MAJOR REASON FOR VISIT, MALES BY RACE, 2011 AND 2016
10. FIGURE 14.10. MAJOR REASON FOR VISIT, FEMALES BY RACE, 2011 AND 2016
11. FIGURE 14.11. TOP FIVE CHRONIC DISEASES, PERCENT, BY AGE, 2016
12. FIGURE 14.12. TOP FIVE CHRONIC DISEASES, PERCENT, BY SEX, 2016

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Library of Congress Cataloging‐in‐Publication Data

Names: Fos, Peter J., author. | Fine, David J., author. | Zúniga, Miguel A., author.

Title: Managerial epidemiology for health care organizations / by Peter J. Fos, David J. Fine, Miguel A. Zúniga.

Description: Third edition. | Hoboken, NJ : Jossey-Bass & Pfeiffer Imprints, Wiley, 2018. | Includes bibliographical references and index.

Identifiers: LCCN 2017036577 (print) | LCCN 2017037420 (ebook) | ISBN 9781119398820 (pdf) | ISBN 9781119398837 (epub) | ISBN 9781119398813 (pbk.)

Subjects: | MESH: Epidemiologic Methods | Epidemiology—organization & administration | Health Services Administration | Quality of Health Care

Classification: LCC RA652 (ebook) | LCC RA652 (print) | NLM WA 950 | DDC 614.4—dc23

LC record available at https://lccn.loc.gov/2017036577

Cover Design: Wiley
Cover Image: ©urbancow/iStockphoto

THIRD EDITION

LIST OF TABLES, FIGURES, AND EXHIBITS

Tables

2.1 Number, Percent Distribution, and Rate of Injury‐Related Emergency Department Visits, by Age, 2011
2.2 Percent of Persons Lacking Health Insurance, States with State‐Based Marketplace, 18 to 64 Years of Age, 2010–2016
2.3 Cancer Death Rates, by Age, United States, 2013
2.4 Tuberculosis Cases, by Age, United States, 2013
2.5 Deaths, by Sex, United States, 2014
2.6 Number, Percent Distribution, and Rate of Injury‐Related Emergency Department Visits, by Age and Sex, 2011
2.7 Emergency Department Visits, by Race, United States, 2011
2.8 Frequency of Cancer Deaths, by Race and Cancer Site, per 100,000 Population, United States, 2013
2.9 Frequency of New Cancer Cases, by Race and Cancer Site, per 100,000 Population, United States, 2013
2.10 Chronic Disease Risk Factors and Marital Status, 2010
2.11 Percentage of Uninsured Persons Under 65 Years of Age, and Poverty Status, United States, 2005–2016
2.12 Percentage of Persons Lacking Health Insurance Coverage, by Educational Status, United States, 2015
2.13 Inpatient Discharges from Short‐Stay Hospitals, by Region, United States, 2010
2.14 Emergency Department Visits, by Season of the Year, United States, 2011
2.15 Inpatient Deaths, per 100 Persons Hospitalized for Diagnosis, by First‐Listed Diagnosis, United States, 2000, 2005, 2010
2.16 Number and Percent of Emergency Department Visits, by Source of Payment, United States, 2011
2.17 Notifiable Diseases, United States, 2016
3.1 Cases of AIDS, by State, United States, 2013
3.2 Top Ten States by Number of New HIV Diagnoses, United States, 2014
3.3 HIV Case Rate per 100,000 Population, United States, 2012
3.4 Number of Visits with a Doctor or Other Health Care Professional, Adults 18 Years of Age and Older, by Age, Sex, and Race, United States, 2014
3.5 Emergency Department Visits, United States, 2011
3.6 HIV Cases Ratios, by Race and Transmission, United States, 2010–2013
3.7 Age‐Adjusted Diabetes Prevalence Ratios, by Sex and Education Attainment, Mississippi, 2005–2013
3.8 Home Health and Hospice Care Agencies, by Ownership, Geographic Region, and Location, United States, 2014
3.9 Incidence Rate of Selected Infectious Diseases, by Year, United States, 2000–2013
3.10 Age‐Adjusted Invasive Cancer Incidence Rates, by Race, California, 2013
3.11 Asthma Prevalence Rate, by Race and Sex, 2014
3.12 Prevalence of Women Aged 18 and Older Who Reported Receiving a Papanicolaou Test During the Past Three Years, per 100 Population, by Age, Selected States and Territories, United States, 2014
3.13 Prevalence of Women Aged 50 and Older Who Reported Having a Mammogram During the Past Two Years, per 100 Population, by Race, Selected States, United States, 2014
3.14 Crude Death Rate, by Sex and Race, United States, 2011–2012
3.15 Cause‐Specific Mortality Rates for Several Causes of Death, United States, 2014
3.16 Age‐specific Mortality Rate, Malignant Neoplasm, United States, 2012
3.17 Case‐Fatality Rate, by Pathogen, Foodborne Infections, United States, 2010
3.18 Infant Mortality Rate, by Race of Mother, United States, 1990–2012
3.19 Neonatal Mortality Rate, by Race of Mother, United States, 1990–2012
3.20 Post‐Neonatal Mortality Rate, by Race of Mother, United States, 1990–2012
3.21 Proportionate Mortality Ratio Among Plumbers, Pipe/Steam Fitters, White Men, by Age, United States, 1971–1995
3.22 Potential Years of Life Lost Calculation Method, Using Individual‐Level Information
3.23 Potential Years of Life Lost Calculation Method, Using Age Group Information
3.24 Potential Years of Life Lost, Before Age 75, for Selected Causes of Death, United States, 1990–2014
3.25 Mental Health Status Among Diabetics, Mississippi, 2003–2013
4.1 Calculation of Relative Risk
4.2 Association of Smoking and Coronary Heart Disease (CHD)–Relative Risk Analysis
4.3 Retrospective Study Design 2 by 2 Table
4.4 Association Between Smoking and Coronary Heart Disease (CHD)–Proportions Analysis
4.5 Odds Ratio Calculation
4.6 Association Between Smoking and Coronary Heart Disease (CHD)–Odds Ratio Analysis
4.7 Births and Cesarean Sections in the Study Population
4.8 Total Live Births Among Medicaid Beneficiaries
4.9 Cesarean Section Rate and Relative Risk, by Age of Mother
4.10 Cesarean Section Rates and Relative Risk, by Locale
4.11 Myocardial Infarction Rates, per 100,000 Population and HIV Status
4.12 Risk Factors for Falls in Elderly Population
5.1 Outpatient Department Visits, by Age and Sex, United States, 2011
5.2 Lung Cancer and Alcohol Use
5.3 Stratification by Smoking Status
5.4 Standardization of Outpatient Department Visits, by Sex, United States, 2011
5.5 Crude Case‐Fatality Rates, by Age
5.6 Standardized Case‐Fatality Rates
5.7 Standard (Combined) Population
5.8 Standardized Case‐Fatality Rates Using Combined Standard Population
5.9 Outpatient Visits, by Age and Race, United States, 2011
5.10 Indirect Standardization of Outpatient Visits Rate
5.11 Screening Program Data
5.12 Indirect Standardization
5.13 Hospital Standardized Mortality Ratio Calculation
5.14 Severity of Illness Distribution
5.15 Recovery Distribution
5.16 Stratum‐Specific Rates
5.17 Crude Rates for Outpatient Visits in the Hancock Regional Hospital Network
5.18 Crude Rates for Outpatient Visits in the Harrison Hospital System
5.19 Population Distribution, Hancock Regional Hospital Network
5.20 Population Distribution, Harrison Hospital System
5.21 Standard Population Crude Outpatient Department Visit Rates
5.22 Age‐Specific Rate and Expected Cases for Hancock Regional Hospital Network
5.23 Age‐Specific Rate and Expected Cases for Harrison Hospital System
5.24 Age‐Specific Rate and Expected Cases for Hancock Regional Hospital Network Using Combined Population
5.25 Age‐Specific Rate and Expected Cases for Harrison Hospital System Using Combined Population
5.26 Crude Rate for MI Complications in Jefferson County
5.27 Crude Rate for MI Complications in Washington County
5.28 Population Distribution, Jefferson County
5.29 Population Distribution, Washington County
5.30 Standard Population Crude MI Complication Rates
5.31 Expected MI Complications, Jefferson County
5.32 Expected MI Complications, Washington County
6.1 Calculation of Likelihood Ratios in Tests with Dichotomous Results
6.2 Calculation of Likelihood Ratios in Tests with Polychotomous Results
6.3 Mammography and Pap Smears Results for Fiscal Year 2015–2016
6.4 Screening Test for Diabetes
7.1 Worldwide Impact of SARS, July 2003
7.2 West Nile Virus Cases, United States, 2016
7.3 Results of Gastritis Investigation
8.1 Incidence of CVD in the East Bank Regional Hospital Service Area
10.1 Cost Analysis, Year 1
10.2 Program Costs, by Year
10.3 Cost‐Effectiveness of Diagnostic Interventions
10.4 Benefits of Community Outreach Program
10.5 Cost‐Utility Analysis of Treatment Approaches
10.6 Leading Causes of DALYs, Worldwide, 2000
10.7 Leading Causes of DALYs, Worldwide, 2012
10.8 Leading Causes of Death, Worldwide, 1990 and 2020
10.9 Costs of Initiatives, Six‐Month Period
11.1 Population Characteristics, by Age
11.2 Persons with One Hospital Stay in the Past Year, by Age, Sex, and Race, Percent, 1999–2016
11.3 Persons with Two or More Hospital Stays in the Past Year, by Age, Sex, and Race, Percent, 1999–2016
11.4 Discharges, by Age and Sex, 2014–2016
11.5 Discharges with at Least One Procedure, 2011, 2016
11.6 Discharges with at Least One Procedure, by Age, 2011
11.7 Discharges with at Least One Procedure, by Age, 2016
11.8 Average Length of Stay, by Age and Sex, 2014–2016
11.9 Percent Occupancy Rate, by Hospital, 2014–2016
11.10 East Bank Hospital System Service Area Insurance Coverage, Persons Under 65, Percent, by Age, Sex, and Race
11.11 Medicaid Coverage in the East Bank Hospital System Service Area, by Age, Sex, and Race, 2014–2016
11.12 Medicare Coverage in the East Bank Hospital Service Area, by Age, Sex, and Race, 2011, 2016
11.13 East Bank Hospital System Service Area Cancer Incidence Rates, per 100,000 Population, by Race and Sex
11.14 East Bank Hospital System Service Area Prevalence of Heart Disease, Cancer, and Stroke, Percent, 2016
11.15 East Bank Hospital System Service Area Prevalence of Diabetes and Poor Glycemic Control, by Age, Sex, Race, and Poverty Level, Percent, 2016
11.16 Chronic Diseases in the East Bank Hospital System Service Area, by Age, Sex, Race, and Insurance Coverage, Percent, 2016
12.1 Population, East Bank County
12.2 Population, Lakeshore County
12.3 Users of Long‐Term Care Services, Lakeshore County
12.4 Users of Long‐Term Care Services, East Bank County
12.5 Usage Rate of Long‐Term Care Services, per 1,000 Persons 65 Years and Older, by Age, Lakeshore County and WEC‐LC
12.6 Usage Rate of Long‐Term Care Services, per 1,000 Persons 65 Years and Older, by Age, East Bank County and WEC‐EB
12.7 Current Long‐Term Care Staffing, Lakeshore County
12.8 Current Long‐Term Care Staffing, East Bank County
13.1 Emergency Department Visits, by Age
13.2 Emergency Department Visits, by Age and Sex
13.3 Emergency Department Visits, by Age and Race
13.4 Injury Visits to the Emergency Department, by Age and Sex
13.5 Injury Visits to the Emergency Department, by Age and Race
13.6 Primary Payment Source
13.7 Wait Time and Time Spent in Emergency Department
13.8 Leading Primary Diagnosis Groups at Arrival
13.9 Disposition of Emergency Department Visits
13.10 Visits Resulting in Hospital Admission
13.11 Leading Principal Hospital Discharge Diagnosis Groups for Emergency Department Visits
14.1 Age Distribution of Adult Population, East Bank City, 2016
14.2 Crescent Doctors, Ltd., Patient Population, by Age and Sex, 2011 and 2016
14.3 Crescent Doctors, Ltd., Patient Population, by Age and Race, 2011 and 2016
14.4 Percent Distribution Length of Time Since Last Visit, Adult Patients, 2016
14.5 Percent Insurance Coverage, Adults Under 65 Years of Age, 2016
14.6 Percent Insurance Coverage, Adults Over 65 Years of Age, 2016
14.7 Percent Distribution Major Reason for Office Visit, by Age, 2011 and 2016
14.8 Percent Distribution Major Reason for Office Visit, by Sex and Race, 2011 and 2016
14.9 Preventive Care Visits, by Age, Sex, and Race, 2016
14.10 Presence of Selected Chronic Conditions, Percent Distribution, by Age, 2016
14.11 Presence of Selected Chronic Conditions, Percent Distribution, by Sex, 2016

Figures

1.1 Epidemiologic Data
2.1 Population Pyramid, United States, 2016
2.2 Foodborne Outbreak
3.1 Incidence Rate of Readmissions
4.1 A 2 by 2 Contingency Table
4.2 Experimental Study Designs
4.3 Framework of Randomized Controlled Clinical Trials
4.4 Observational Study Designs
5.1 Direct Method of Standardization
5.2 Indirect Method of Standardization
6.1 Validity 2 by 2 Contingency Table
6.2 Validity Parameters for Arthritis Screening Tests
6.3 Validity Parameters for Arthritis Screening Tests, Prevalence of 10 Percent
6.4 Validity Parameters for Colorectal Cancer Screening
6.5 Predictive Validity of Preadmission Screening Test
6.6 Reliability Index
6.7 Reliability Index Calculation
6.8 Likelihood Ratios
6.9 ROC Curve
7.1 Common‐Source Outbreak
7.2 Propagated Epidemic
8.1 RVU Calculation
9.1 Patient Satisfaction Control Chart
9.2 Control Chart for Patient Falls
9.3 Quality Control Chart
10.1 Outcomes of Economic Evaluations
10.2 Present Value of Community Outreach Program
10.3 Present Value of In‐Hospital Program
10.4 Discounted Benefits of Community Outreach Program
10.5 Discounted Benefits of In‐Hospital Program
10.6 Cost‐Effectiveness Ratio
11.1 Service Area Population, Percent Distribution
11.2 Percent of Patients with One Hospital Stay, 1999–2016, by Age
11.3 Percent of Patients with Two or More Hospital Stays, 1999–2016, by Age
11.4 Discharges by Sex, per 10,000 Population, 2014–2016
11.5 Average Length of Stay, by Age, 2014–2016
11.6 Occupancy Rate, Percent, by Hospital, 2014–2016
11.7 Prevalence of Diabetes and Poor Glycemic Control, 2016
12.1 Population Characteristics, by Race, East Bank County
12.2 Population Characteristics, by Age, East Bank County
12.3 Population Characteristics, by Race, Lakeshore County
12.4 Population Characteristics, by Age, Lakeshore County
12.5 Number of Users of Long‐Term Care Services, Lakeshore County
12.6 Number of Users of Long‐Term Care Services, East Bank County
12.7 Percent Users of Adult Day Care, by Age, Lakeshore County
12.8 Percent Users of Adult Day Care, by Age, East Bank County
12.9 Percent Users of Home Health Services, by Age, Lakeshore County
12.10 Percent Users of Home Health Services, by Age, East Bank County
12.11 Percent Users of Hospice Services, by Age, Lakeshore County
12.12 Percent Users of Hospice Services, by Age, East Bank County
12.13 Percent Users of Nursing Services, by Age, Lakeshore County
12.14 Percent Users of Nursing Services, by Age, East Bank County
12.15 Percent Users of Residential Care Community, by Age, Lakeshore County
12.16 Percent Users of Residential Care Community, by Age, East Bank County
12.17 Usage Rate of Long‐Term Care Services Among Persons 65 Years and Older, per 1,000 People 65 Years and Older, by Age, Lakeshore County and WEC‐LC
12.18 Usage Rate of Long‐Term Care Services Among Persons 65 Years and Older, per 1,000 People 65 Years and Older, by Age, East Bank County and WEC‐EB
12.19 Usage Rate of Long‐Term Care Services Among Persons 85 Years and Older, per 1,000 People 65 Years and Older, by Age, Lakeshore County and WEC‐LC
12.20 Usage Rate of Long‐Term Care Services Among Persons 85 Years and Older, per 1,000 People 65 Years and Older, by Age, East Bank County and WEC‐EB
13.1 Emergency Department Visits, by Age
13.2 Emergency Department Visits, by Age and Sex
13.3 Utilization Rate of Emergency Department Visits, by Age and Sex
13.4 Emergency Department Visits, by Age and Race
13.5 Utilization Rate of Emergency Department Visits, by Age and Race
13.6 Rate of Injury‐Related Emergency Department Visits, by Age
13.7 Rate of Injury‐Related Emergency Department Visits, by Age and Sex
13.8 Rate of Injury‐Related Emergency Department Visits, by Age and Race
13.9 Primary Payment Source, Percent
13.10 Wait Time in Emergency Department, by Number of Visits
13.11 Wait Time in Emergency Department, Percent
13.12 Duration of Emergency Department Visit, by Number of Visits
13.13 Duration of Emergency Department Visit, Percent
13.14 Primary Diagnosis at Arrival, Percent, Selected Diagnoses
14.1 Age Distribution, Percent
14.2 Office Visits, by Age, Percent, 2011 and 2016
14.3 Office Visits, Whites, Percent, 2011 and 2016
14.4 Office Visits, Blacks/African Americans, Percent, 2011 and 2016
14.5 Payment Sources, Adults Under Age 65, Percent
14.6 Payment Sources, Adults Over Age 65, Percent
14.7 Major Reason for Visit, by Age, 2011 and 2016
14.8 Major Reason for Visit, by Sex, 2011 and 2016
14.9 Major Reason for Visit, Males by Race, 2011 and 2016
14.10 Major Reason for Visit, Females by Race, 2011 and 2016
14.11 Top Five Chronic Diseases, Percent, by Age, 2016
14.12 Top Five Chronic Diseases, Percent, by Sex, 2016

Exhibits

2.1 ICD‐10‐CM Codes
2.2 Nationally Notifiable Infectious Diseases, United States, 2016
9.1 AHRQ Checklist

PREFACE

This book is intended to introduce the student and practitioner of health care management to the notion of health care for populations and the science of epidemiology. When the first edition of this book, Designing Health Care for Populations: Applied Epidemiology in Health Care Administration (Jossey‐Bass, 2000), was written almost 20 years ago, outside the field, epidemiology was viewed by many as a questionably relevant, but certainly complicated set of terms, formulas, and statistics. This view was also prevalent when the second edition, Managerial Epidemiology for Health Care Organizations (2nd edition; Jossey‐Bass, 2005), was published. However, given the recent changes in health care reform, epidemiology is now recognized as a core discipline pertinent to all branches of health care, including management. The initial motivating purpose of the text was to illustrate both the relevance and benefit of epidemiology in the field of health care management and population health management.

This is still the case with this latest edition. This revised edition has been jointly written by authors who bring a medical, managerial, and epidemiological perspective to the work. Contemporary applications of epidemiology in health care management include monitoring quality and effectiveness of clinical services, strategic and program planning, marketing, and insurance and managed care—as well as such traditional uses as tumor registries, infection control programs, and public health programming. This newest version has been written to introduce epidemiology principles, reinforce the traditional uses of contemporary epidemiology, and attempt to illustrate clearly the contemporary uses in planning, evaluating, and managing health care for populations. Health care reform initiatives are discussed throughout, with emphasis on the influence of epidemiological principles.

Perhaps the most important purpose of this book is teaching the practical application of epidemiology in health care management. Each chapter has been written to present epidemiologic principles, followed by examples and applications. Concepts, examples, and case studies are presented to allow the student and practitioner a way to understand epidemiology and its application in the design and management of health care for populations.

The text is organized in the following manner. Chapter One introduces the reader to the science of epidemiology. Definitions of epidemiology and an overview of its history in management are presented. Also, the transition from the traditional role of health care management to its new role in population health is outlined. A historical perspective on the development of epidemiology into a scientific discipline is presented. Recent health care reform is presented.

Chapter Two discusses the health and needs of populations and its use in management. Included in this chapter is a discussion of commonly available sources of data. Chapter Three presents epidemiological measures used in health care, with emphasis on those measures of importance to managers. Chapter Four presents study designs and measures of association of the cause and effect relationship of health and disease across and among populations. Clinical trials, as an example of experimental study designs, are presented, along with the more commonplace observational designs. Chapter Five introduces the concept of confounding, the problem of misleading data interpretation, and methods to address this problem. Included in this chapter is a discussion of the standardization of epidemiologic data and risk adjustment.

Chapter Six introduces clinical epidemiology as the core discipline of clinical outcomes research, clinical effectiveness, and medical management. This chapter covers topics including validity and reliability and other measures of test performance. Chapter Seven, which is a new chapter in this edition, presents infectious disease epidemiology, including epidemiological surveillance and monitoring infections. Health care–associated infections are discussed. Chapter Eight, another new chapter, covers reimbursement methods in use today and the role of epidemiology in determining reimbursement and performance. Chapter Nine provides a discussion of health outcomes assessment and the relationship between traditional epidemiological concepts; benchmarking, best practice, practice guidelines, and the measurement of quality of care are presented.

Chapter Ten describes the relationship between epidemiology and economic analysis, including the manner in which epidemiological measures are used in the evaluation of health care delivery and the formulation of health care policy for populations. Burden of disease is discussed, with a focus on the economic impact of disease.

Chapters Eleven through Fourteen present case studies of the application of epidemiology to the planning for and management of health care for populations. Chapter Eleven presents a case study focusing on hospital inpatient services. The intent of this chapter is to apply general concepts presented throughout the text to establishing a plan for realignment of inpatient hospital services. Chapter Twelve presents a case study focusing on long‐term care. Chapter Thirteen presents a case study illustrating the application of epidemiology to the study of emergency room services in a hospital network. Chapter Fourteen presents a case study focusing on physician practices.

Each chapter is supplemented with study questions. The purpose of the study questions is to aid the reader in understanding and applying the epidemiologic concepts presented within a management context.

We anticipate that the primary users of this text will be health care management students and practitioners, for whom we have presented the material in a practical and applied manner. This book can serve as a classroom text as well as an on‐the‐job reference for practitioners. After reading and using this book, we expect that the student or practitioner will understand and appreciate the relevance of epidemiology and look forward to using it in everyday health care management practice.

The preparation of this work has been the result of a multiyear collaboration, whose first product was the previously mentioned text. The authors of the first two editions have worked together for more than 30 years. This edition has a third author, who was our student and now is a colleague.

Finally, we would like to thank the students at Tulane University Medical Center School of Public Health and Tropical Medicine, the University of Wisconsin‐Madison Medical School, the University of Indiana at South Bend, the University of St. Thomas Graduate School of Business, the University of Alabama Birmingham, School of Health Related Professions whose comments on previous work have been incorporated into all editions. Their collective feedback has improved this book significantly from its previous incarnations. Errors of omission remain the responsibility of the authors.

PJF

DJF

MAZ