Research the two diseases HIV and HCV. Based on your research, discuss whether you think that a vaccine will be developed for either of these diseases within the next ten years. Why or why not?

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Discussion – Viral Treatment Options

There are many opinions on the need and/or importance of vaccines in preventing the spread of disease. Our children are required to get vaccinations before entering school, and health care workers must have them when working in environments where they can encounter bloodborne pathogens.

Human immunodeficiency virus (HIV) and Hepatitis C (HCV) are the two more prominent concerns for medical staff and for the worldwide community. Despite precautions, these diseases are both considered emerging infections. Neither of them have had vaccines developed that are effective at preventing the contraction of the disease.

For your initial post, research the two diseases HIV and HCV. Based on your research, discuss whether you think that a vaccine will be developed for either of these diseases within the next ten years. Why or why not?

 

How has your definition of diversity changed? How do the four lenses approach the study of diversity with respect to the individual and society? How do the four lenses represent a way of seeing diversity?

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Module One discussion

In this final discussion, look back on your experiences in the course and provide an overview of what you have learned from the course with regard to diversity. You can start by reviewing your final projects and your answers to the Module One discussion. In your initial post, address the following questions:

  • How has your definition of diversity changed?
  • How do the four lenses approach the study of diversity with respect to the individual and society?
  • How do the four lenses represent a way of seeing diversity?
  • What are the implications of diversity on the future?
  • How are you going to implement what you have learned in this course into your own life?

In your response posts, compare your experience to your peers’ experiences.

  • Compare similarities and differences between your plan for implementing what you have learned throughout the course and your peers’.
  • How do your peers approach the study of diversity through the four lenses, and how could their insights be useful to you?

Required Resources

Bottom Line: Empathy

In this article, author Art Munin describes how racism and biases permeate many aspects of people’s lives and encourages educators to teach on topics of diversity using an empathetic approach.

The Four General Education Lenses

This document provides a brief explanation of the lenses through which we analyze diversity, including links to brief videos that explain the lenses and methods used. As you review this document and watch the videos, consider how each lens intersects when we look at diversity. Further, consider the following:

  • How do these lenses talk to one another to address various issues in diversity?
  • How does each lens comment on society as a whole and impact changes within our personal and professional lives?
  • What is the value of analyzing diversity through these varying perspectives?

 

Pick a mental illness and briefly describe it. Briefly describe PTSD Describe both the behavioral and biological components of the disease. What treatment options exist for each component of the disease?

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Mental Illness

According the National Alliance on Mental Illness (2016), 1 in 5 adults will experience mental illness each year–that’s 20% of the American population. Examples of mental illness include anxiety, depression, post-traumatic stress disorder, and schizophrenia. Like other chronic conditions, mental illnesses are marked by behavioral and biological components.

For your initial post, address the following:

  • Pick a mental illness and briefly describe it. Briefly describe PTSD
  • Describe both the behavioral and biological components of the disease. What treatment options exist for each component of the disease?

 

What kinds of health systems do you see as most closely supporting your topic? Would these be part of the public, private or informal sectors? How might the health systems you have identified be different if you lived instead in one of the poorest countries in the world?

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Chapter 8 in Global Public Health

Think about health systems and how they impact your own community, and the public health issues you are selected as your focus for this class. Using Chapter 8 in Global Public Health to guide you, respond to the following questions this week:

  • What kinds of health systems (organizations, institutions, resources) do you see as most closely supporting your topic?
  • Would these be part of the public, private or informal sectors?
  • How might the health systems you have identified be different if you lived instead in one of the poorest countries in the world?
  • Would any supporting health systems exist in that situation?
  • How do economic systems impact your selected topic?
  • For this discussion there is no single correct response format, so be creative as you interpret the information from Chapter 8 and relate it to your selected project topic.

Your response should be approximately 150-200 words in length and include supporting sources.

 

Submit a draft of your implementation section. Give a detailed description of the activities leading to achieving the objectives, including your rationale behind their selection, their sequence, and your reasoning behind why these methods may work.

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Milestone 5

American Healthcare Patient Safety
For this milestone, submit a draft of your implementation section. Give a detailed description of the activities leading to achieving the objectives, including your rationale behind their selection, their sequence, and your reasoning behind why these methods may work.

Provide a brief description of how your organization (and potential funders) will know the program is successful. Include a description of the analysis and collection of data for your program proposal.

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6-1 Discussion

American healthcare patient safety is the topic that needs to be used.
Begin with a one-sentence summary of your proposal topic. Then, provide a brief description of how your organization (and potential funders) will know the program is successful. Include a description of the analysis and collection of data for your program proposal.

Reflect on the importance of this 40-year atrocity in U.S. Public Health history. What are the ethical principles involved? How has this experiment changed the way research is currently conducted? How else has it affected the field of Public Health?

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The Tuskegee Experiment

Watch the links and answer the questions below.

1. Reflect on the importance of this 40-year atrocity in U.S. Public Health history.
2. What are the ethical principles involved? How has this experiment (and others like it) changed the way research is currently conducted?
3. How else has it affected the field of Public Health?
4. Do you believe a similar experiment could be conducted in this manner today?

Identify and describe the components, process, and impact of MS-DRG on the healthcare systems related to the coding and billing process in a healthcare facility. Identify and describe the function and structure the coding process.

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Case Study: Coding Accuracy

Source: United States Department of Health and Human Services. (1999). Monitoring the accuracy of hospital coding.

 

BACKGROUND

In our recent report, Using Software to Detect Upcoding of Hospital Bills (OEI-01-97-00010), we examined the ability of commercially available software to identify DRG upcoding through analysis of electronic claims data. We used two software products to identify 299 hospitals with a high suspected rate of upcoding. We then used accredited medical records professionals to perform a blinded DRG validation on a sample of over 2,600 claims from 50 of these hospitals and a control group of 20 hospitals.

In the course of conducting this study, we developed serious concerns about the potential for abuse of the DRG system through upcoding and about HCFA’s oversight of the accuracy of DRG coding. Specifically, we found that, although the hospital payment system is functioning well as a whole, the system has significant vulnerabilities to upcoding that can easily be avoided. We also found that, despite these vulnerabilities, HCFA is not performing routine, ongoing monitoring and analysis of DRG coding to detect problematic DRGs, hospitals, and coding situations that require administrative, educational, or law enforcement intervention.

 

FINDINGS

The DRG system is vulnerable to abuse by providers who wish to increase reimbursement inappropriately through upcoding, particularly so within certain DRGs. Our analysis found noticeable, detectable, and curable upcoding abuses among providers and within specific DRGs.

In a focused sample from a group of 299 hospitals that computer software identified as high upcoders, we found that an average of 11 percent of DRG bills submitted during 1996 were upcoded, versus 5 percent of bills among a control sample of hospitals.

 

 

 

Identifying Hospitals That Upcode
  Average

Upcoding Rate

 Average

Downcoding Rate
OIG Experimental sample – hospitals with a high predicted rate of upcoding (n=50)  

11.4%

  

5.1%
OIG Control sample – hospitals without a high predicted rate of upcoding (n=20)  

5.2%

  

3.9%
Source: Office of Inspector General, Using software to detect upcoding of hospital bills (OEI-01-97-00010), August 1998.

 

The average rate of upcoding in the control sample of hospitals (those without a high predicted rate of upcoding) was not statistically different from the average downcoding rate. However, among hospitals that the software predicted would have a high rate of upcoding, the average upcoding rate was more than twice that of downcoding. The difference between upcoding and downcoding in these hospitals suggests intentional abuse of the DRG system by some providers.

Using data from both our focused review and the more broadly representative 1996

DRG validation performed by HCFA’s clinical data abstraction centers (CDAC), we found that certain DRGs are particularly susceptible to upcoding.

 

Three Highly Vulnerable DRGs
   

OIG Experimental

Sample

  

OIG Control

Sample

  

CDAC Sample
Up- coded Down- coded Up- coded Down- coded Up- coded Down- coded
 

DRG 79:

Respiratory Infections

  

37.7%

(n=60)

  

0.0%

(n=0)

  

18.5%

(n=5)

  

0.0%

(n=0)

  

11.0%

(n=48)

  

0.7%

(n=3)
DRG 416: Septicemia 21.2%

(n=14)

 0.0%

(n=0)

 16.7%

(n=3)

 0.0%

(n=0)

 13.3%

(n=49)

 1.1%

(n=4)
DRG 14: Specific Cerebrovascular Disorders 10.1%

(n=10)

 0.0%

(n=0)

 6.7%

(n=2)

 0.0%

(n=0)

 3.5%

(n=24)

 0.4%

(n=3)

 

Claims billed for these three DRGs show a clear pattern that exemplifies the upcoding seen in a group of over half a dozen DRGs we examined. These DRGs were upcoded disproportionately, especially by our experimentally identified upcoding hospitals, but also among hospitals from the general population represented by the CDAC review and our control sample.

The HCFA does not routinely analyze readily available billing and clinical data that could be used to proactively identify problems in DRG coding. The HCFA does not routinely analyze data from the annual validation of DRG coding performed by its clinical data abstraction centers.

Since 1995, HCFA has used two specialized contractors called clinical data abstraction centers to validate the DRGs on an annual national sample of over 20,000 claims billed to Medicare. On a monthly basis, the CDACs report detailed data on each claim reviewed to HCFA’s Office of Clinical Standards and Quality. These data include original and validated diagnostic coding, original and validated DRGs, and reasons for any variance between the DRGs. The purpose of this validation effort is to provide HCFA with insight as to the accuracy of DRGs billed to Medicare.

However, we found that HCFA performs no routine, ongoing analysis of CDAC data. In our interviews with staff at the two HCFA components that have responsibility for DRGs—the Office of Clinical Standards and Quality, and the Center for Health Plans and Providers—staff were unable to identify any routine monitoring and analysis of CDAC data. In our review of HCFA’s instructions to the peer review organizations (PROs), contractors who have statutory responsibility for DRG oversight, we found no instructions advising them to perform regular analysis of CDAC data.

Yet we believe that analysis of CDAC data can be of great value to HCFA in overseeing the accuracy of DRG coding. For example, in HCFA’s 1996 DRG validation, the CDACs found a 4 percent upcoding rate with estimated net overpayment of $183 million. Some may suggest that overpayments of $183 million in an $80 billion program (less than one-quarter percent) indicate that the DRG payment system does not have major problems with upcoding and warrants no further analysis. However, our analysis presented above shows that by digging below the immediate surface, upcoding problems are readily apparent.

The HCFA does not routinely analyze data from hospitals, despite the fact that these data are ideally suited for monitoring and analysis of DRGs.

The HCFA maintains valuable clinical, demographic, and administrative data that form the underlying basis of each of the over 10 million DRG-based claims billed to Medicare each year. Data for each hospitalization include diagnosis codes, procedure codes, beneficiary demographics, admission and discharge detail, cost reporting data, and hospital identifier for linkage with provider demographics. Whether used on its own to monitor billing patterns and trends or used to further explore potential problem areas identified within CDAC data, data from hospital claims can provide valuable information to assist in HCFA’s oversight of DRG coding.

However, we found that HCFA does not make routine use of data from hospital claims for monitoring and analysis of DRG coding. In our interviews with staff at both HCFA’s Office of Clinical Standards and Quality and its Center for Health Plans and Providers, staff were unable to identify any routine monitoring and analysis of DRG billing data. Interviews at HCFA’s Program Integrity unit, within the Office of Financial Management, revealed that HCFA conducts some limited analysis of billing data. However, this analysis is done on a very broad level, primarily to identify coverage issues.

We also reviewed HCFA’s current instructions to the Medicare PROs. We found no instructions to the PROs advising them to perform any routine monitoring and analysis of DRG coding, despite the fact that PROs already have a complete set of inpatient billing data provided to them by HCFA. In fact, HCFA staff told us that the PROs were instructed not to do “coding projects” within their current contract. We did find that PROs are involved in sporadic activity around DRG oversight; however, this activity often is in support of an OIG investigation.

 

 

CASE STUDY QUESTIONS

 

  1. Identify and describe the components, process, and impact of MS-DRG on the healthcare systems related to the coding and billing process in a healthcare facility.
  2. Identify and describe the function and structure the coding process.
  3. Why is it important for healthcare administrators to be very familiar with the coding and billing process and ensure their facilities processes are accurate and reliable?
  4. Regarding the case study above, what should HCFA do moving forward with regards to monitoring DRG upcoding?

 

Write a brief summary of the keeper article (up to 250 words per article) using information recorded in the TOEs, in APA format.

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Edit Summary

Edit according to this feedback:

The organization and flow of information within each summary could be improved, and some of the summaries (e.g., the first qualitative article) could be more concise. Further revisions and polishing of all four summaries are needed for the final paper.

Write a brief summary of the keeper article (up to 250 words per article) using information recorded in the TOEs, in APA format. The summary should be written in your own words. Don’t copy and paste from the articles. Try to rephrase/paraphrase to demonstrate your understanding of the research studies. The summary of each research article should include the following components, brief but sufficient that the reader has a thorough understanding of what was studied, how it was done, and what was found (including the main statistics used to support the authors' claims in quantitative studies, and the themes identified in qualitative studies).

These are the sources/articles used. The topic is Klebsiella pneumoniae.

Lyles, R., Moore, N., Weiner, S., Sikka, M., Lin, M., Weinstein, R., . . . Sinkowitz-Cochran, R. (2014). Understanding Staff Perceptions about Klebsiella pneumoniae Carbapenemase–Producing Enterobacteriaceae Control Efforts in Chicago Long-Term Acute Care Hospitals. Infection Control & Hospital Epidemiology, 35(4), 367-374. doi:10.1086/675596
https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/understanding-staff-perceptions-about-klebsiella-pneumoniae-carbapenemaseproducing-enterobacteriaceae-control-efforts-in-chicago-longterm-acute-care-hospitals/E34CF0868EFF3A708C023F5E9A13BD28#

Dai, Y., Meng, T., Wang, X., Tang, B., Wang, F., Du, Y., Qiu, Y., Liu, J., Tan, R., & Qu, H. (2021). Validation and Extrapolation of a Multimodal Infection Prevention and Control Intervention on Carbapenem-Resistant Klebsiella pneumoniae in an Epidemic Region: A Historical Control Quasi-Experimental Study. Frontiers in medicine, 8, 692813. https://doi.org/10.3389/fmed.2021.692813

Li, M., Wang, X., Wang, J., Tan, R., Sun, J., Li, L., Huang, J., Wu, J., Gu, Q., Zhao, Y., Liu, J., & Qu, H. (2019). Infection-prevention and control interventions to reduce colonization and infection of intensive care unit-acquired carbapenem-resistant Klebsiella pneumoniae: a 4-year quasi-experimental before-and-after study. Antimicrobial resistance and infection control, 8, 8.
https://doi.org10.1186/s13756-018-0453-7

Stube, M., Herman, C. T. S., Benetti, E. R. R., & Stumm, E. M. F. (2013). The Nurse in the Prevention of Infection in Intensive Care. Journal of Nursing UFPE / Revista de Enfermagem UFPE, 7(12), 6989–6997. https://doi.org/10.5205/reuol.4767-42136-1-ED.0712esp201305.

Write two pages with background information about the gluten free diet for hashimotos patients. Include informational studies, peer reviewed articles, etc.

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Group paper

Topic is the gluten free diet for Hashimotos patients.

Write two pages with background information about the gluten free diet for hashimotos patients. Include informational studies, peer reviewed articles, etc.