Epidemiological

Basis of
Health care

 Epidemiologi secara formal didefinisikan dalam

beberapa arti.Pertama, epidemiologi adalah ilmu
yang mempelajari distribusi dan faktor-faktor
penentu penyakit dan cedera dalam populasi
manusia (Mausner and Kramer, 1985). A
Definisi kedua menekankan studi tentang semua
faktor yang mempengaruhi terjadinya kesehatan
dan penyakit dalam populasi dan saling
ketergantungan diantara mereka.
Akhirnya, epidemiologi adalah ilmu yang
mempelajari distribusi dan faktor-faktor penentu
kesehatan yang berhubungan dengan negara dan
peristiwa dalam populasi tertentu dan aplikasi ilmu
ini untuk mengendalikan masalah kesehatan (Last,
1995).

 Pada awal abad ke dua puluh satu,

epidemiologi telah mulai memperluas fokusnya
pada status kesehatan, kualitas kesehatan
yang berhubungan dengan kehidupan, dan
beban penyakit.Sebagai akibat serangan
teroris di Amerika Serikat pada tanggal 11
September 2001, epidemiologi telah
mengambil peran baru dalam kesiapsiagaan
bioterorisme dan manajemen pelayanan
kesehatan.Dengan munculnya penyakit
menular dalam yang jumlah signifikan
(termasuk AIDS dan SARS), peran awal
epidemiologi dalam studi epidemi akan kembali
menonjol

 Epidemiologi dan pengobata selalu dikaitkan

sebagai disiplin ilmiah.Epidemiologi merupakan
perangkat yang penting dari kesehatan
masyarakat dan kedokteran
pencegahan.Penggunaan tertentu epidemiologi
termasuk menentukan etiologi atau faktor
penyebab penyakit; menjelaskan faktor-faktor
yang berkaitan dengan kondisi yang merugikan;
diagnosis distribusi penyakit dalam komunitas;
memprediksi terjadinya, dampak, dan distribusi
penyakit; memperkirakan risiko seseorang
menderita penyakit; mengevaluasikegiatan
intervensi pencegahan dan terapeutik;
mengukur keberhasilan tindakan kesehatan;
mempelajari sejarah tren penyakit; identifikasi
sindrom penyakit; perencanaan untuk
kebutuhan kesehatan saat ini, dan memprediksi
kebutuhan masa depan.

 Status kesehatan populasi secara

keseluruhan adalah perhatian penting
dari perawatan kesehatan di model
manajemen perawatan kesehatan
penduduk.Memahami pola kesehatan dan
penyakit dalam populasi memungkinkan
untuk perencanaan yang tepat untuk
layanan dan program untuk memenuhi
kebutuhan layanan kesehatan yang sah
perawatan kesehatan Kontemporer harus
bisa memperoleh data dan memahami
masyarakat dengan melakukan studi
investigasi mereka sendiri pada populasi
dilayani.Pengetahuan tersebut akan
penting untuk profitabilitas

data epidemiologi dan informasi akan menjadi penting bagi

manajer perawatan kesehatan.data epidemiologi telah menjadi
sumber yang berguna untuk informasi yang dapat menuntun
keputusan-keputusan manajerial dan outcome.

Data epidemiologi diperlukan untuk rencana dan desain sistem

perawatan kesehatan, yang didasarkan pada masyarakat dan
kelompok masyarakat.Pengetahuan tentang epidemiologi dan
pemahaman data epidemiologi adalah persyaratan dasar untuk
perawatan kesehatan sukses

What types of epidemiogical

study are there?
Generally epidemiological studies are
used to provide information on three
areas:
1.on the distribution and frequency of
diseases, and on the frequency and
distribution of known and possible
causes of diseases in populations such
studies are usually called descriptive;

2. on the strength of associations

between diseases and other factors
(such as smoking, diet or socioeconomic status), with particular
emphasis on whether such
associations are causal such studies
are usually called analytical;
3. on whether interventions aimed at
preventing a disease or improving its
outcomeactually do so such studies
are usually called intervention studies.

What types of epidemiogical

study are there?

What types of epidemiogical

study are there?

What are intervention

studies used for and what
types are there?

The key difference between

analytical and intervention studies is
this: in an analytical study the
investigator simply observes the
exposure status of individuals; in an
intervention study the investigator
intervenes to change the exposure
status of individuals to determine
what happens when this is done

intervention studies
Clinical trials
In a clinical trial one group of individuals
receive an intervention and are compared
to another group who do not receive the
intervention. Clinical trials are often
divided into two types: therapeutic or
secondary prevention trials, and
preventive or primary prevention trials.

 Therapeutic trials are conducted among

patients with a particular disease or health
problem to determine the ability of an
intervention (such as a drug, changes in diet,
or psychological counselling) to reduce
symptoms, prevent recurrence, or decrease the
risk of death from that disease.
A preventive trial is used to evaluate whether
an intervention reduces the risk of developing a
disease among those who are free from it when
they enter the trial.

intervention studies
Community Trial
In a community trial the units of study are
communities rather than individuals. This is
particularly appropriate for diseases that have
their origins in social, cultural or environmental
conditions, where it makes sense to try and
change these conditions on a community-wide
basis rather than an individual basis. For
example, a community trial aimed at changing
diet might include widespread information
campaigns using the local media, as well as
measures to increase the availability of healthy
foods in the local shops.

Health status
health has been traditionally measured as
ill health and its severe manifestations.
Health status is a term that describes a
measurement of health for a population.
Health status has become a
multidimensional construct (Patrick and
Erickson, 1993). The dimensions of health
status include premature mortality, disease
symptoms, physiologic states, physical
functions, emotional functions, cognitive
functions, and health perceptions.

 Health status is measured by many

different scales and indices that
attempt to combine the impact of
morbidity and mortality. Health
status is typically a measure of the
extent to which an individual can
function physically, mentally,
socially, and emotionally.

DESCRIPTION OF HEALTH
Descriptive data offer essential information
regarding health, disease, and disease
patterns, illuminating disease patterns in
terms of person, place, and time.
Descriptions of who is affected, where the
disease occurs, and when it occurs
indicate factors possibly responsible for
high or low frequencies of disease in
specific groups of individuals. Descriptive
data can help identify both high-risk
groups of individuals for future
interventions and problems to be studied
by formal analytic methods.

DESCRIPTION OF HEALTH
In addition to aiding in these public
health efforts, descriptive data are
important to health care administrators
because they provide a basis for
planning, designing, operating, and
evaluating health services. Data
describing trends in health and disease
provide knowledge about the need and
potential demand for health services in
populations that is fundamental to
effective planning.

Descriptive Data
Descriptive data occur in two forms
primary and secondary.
Primary data are directly collected by a
researcher for specific research needs
and objectives. The quality of such data
is carefully controlled, because data
collection is designed to meet the needs
of a specific study. Primary data are
collected in both large populations and
subpopulations. Primary data collection
can be time-consuming, expensive, and
difficult to accomplish effectively.

 Descriptive information is typically

collected according to person, place,
and time. These parameters are
described by several measurable
variables that indicate health and
disease patterns across and within
populations and communities.

 Secondary data are collected, usually on a

routine basis, by such groups as local, state,
national, and international health care
agencies. Although they are less expensive
and easier to obtain than primary data,
secondary data have inherent disadvantages
and are often incomplete or inaccurate.
Recording and presentation of secondary
data can be inconsistent due to the varying
methods of data collection used by different
collectors. Specific information may be
missing, and information may not be
recorded in the desired format. Secondary
data are typically released several years
after being collected.

MEDICAL MANAGEMENT
IN
POPULATION HEALTH
Clinical Effectiveness
CARE

Clinical effectiveness is a concept that

investigates the appropriate use of clinical
resources: whether tests and treatment are
selected appropriately, based on diagnoses.
To determine clinical effectiveness, the
following questions must be answered: Are
the tests accurate? Are the resources used
appropriately? What is the impact of testing
information? What is the diagnostic ability of
the tests?

 Accuracy, efficacy, and efficiency are

indicators of test performance.
Accuracy is defined as the condition of
being true, correct, or exact; efficacy
is the capacity of producing a desired
result or effect (or effectiveness); and
efficiency is the ability to accomplish
a job with a minimum expenditure of
time and effort

 Validity is the construct that measures

the accuracy of a test. By accuracy, we
mean how often a test correctly identifies
individuals with and without a disease.
Validity is also thought of as the ability of
a test to produce a true measure. Validity
is quantified by the parameters known as
sensitivity, specificity, and predictive
values (of positive and negative test
results).

 Validity parameters are determined

by using a 2-by-2 contingency table

Sensitivitas : kemampuan untuk

mengidentifikasi
individu
yang
menderita penyakit secara benar,
(positif sejati).
Spesifisitas :
kemampuan untuk
mengidentifikasi
individu
yang
tidak menderita penyakit secara
benar (negatif sejati).
Berkaitan dengan kemampuan tes tersebut
untuk mengukur apa yang seharusnya
diukur (membedakan individu yang sakit
dengan individu yang tidak sakit)
Tes sensitivitas dan tes spesifisitas

 The presumptive identification of

unrecognised disease or defect by
the application of tests, examinations
or other procedures which can be
applied rapidly. Screening tests sort
out the apparently well persons who
probably have a disease from those
who probably do not. (Last and
Spasoff 2000: 118)

 Why did screening develop?

When initially introduced into health
care, screening only really extended the
therapeutic range. This was obviously
based on the idea that the outcome
could potentially be improved if a
disease process could be identified and
treatment started at an early stage.

Early Intervention in the

Natural History of Disease
Good
Health

Disease
Symptoms Care DiagnosisTherapy
Onset
Seekin
g

Early detection through

Screening

HEALTH
OUTCOMES
Cure
Control
Disability
Death

Comparison between screening and

diagnostic tests
Screening tests

Diagnostic tests

Done to those who are

apparently healthy or
asymptomatic

Done to those with suggestive

signs or symptoms

Applied to a group of
individuals

Applied to a single person

Results are based on

one criterion

Results are based on the

evaluation of a number of
symptoms, signs and
investigations

Results are not

conclusive

Results are conclusive and final

Less accurate

More accurate

Less expensive

More expensive

Not a basis for

Basis for treatment

Diseases for which screening has

been recommended
Cervical cancer
Breast cancer
Ovarian cancer
Colorectal cancer
Skin cancer
Diabetes
Hypertension

More Conditions for Which Screening Is Recommended

Health Outcome
(years)
Obesity

Test(s)

Populations(s)

Age Group

Height/Weight

General

All

CVD/HBP

Blood pressure

General

All

CVD

Cholesterol

General/HR6

25-64/65+

Injury/Liver diseaseAlcohol overuse

General

11+

Colorectal cancer

General

25+

General

50+ (female)

Cervical cancer

Mammography
/Clinical Breast
Exam

General

11+ (female)

Chlamydia

Pap Smear

General/HR4

11-24/11-64

Gonorrhea

Lab

HR2

11-24, 25-64

Syphilis

Lab

HR1/HR9

11-64/65+

Fecal Occult Blood

Test
Sigmoidoscopy

Breast cancer

Source: U.S. Preventive Services task Force [USPSTF] (1996)

Lab

 Understanding population characteristics

is important because health and disease
patterns are identified with respect to
the population at risk or, in this case,
the population to be served. Health and
disease trends are expressed as
epidemiologic measures, that is, rates
and ratios, with geographic and
demographic bounds

Measuring the Quality

of Health Care
The measurement and improvement of
quality of care have been a part of
health care for decades. Recently,
attempts to measure and monitor
quality have become more intense as a
response to demands for accountability
in the delivery of services (Relman
1988) and as an outgrowth of the
quality and outcomes "movement."

Measuring Quality:
Structure, Process,
Outcome
Quality of care can be measured based on

structure, process, or outcome (Donabedian

1980,1982,1985).
Structural measures are the characteristics of
the resources in the health system.
Processes embody what is done to and for the
patient (e.g., ordering of a immunization,
prescription of a medication).
Process measures of quality can be made for
individual practitioners, groups of practitioners,
or for entire systems of care

Measuring Quality:
Structure, Process,
Outcome
Outcomes are the end results of care or
the effect of the care process on the
health and well-being of patients and
populations. Elinson (1987) describes
the relevant health care outcomes as
"the five Ds"death, disease, disability,
discomfort, and dissatisfaction

 Hospital length of stay (in days) is the common

measure used to evaluate system utilization.

 Hospital length of stay (in days) is the common

measure used to evaluate system utilization.