Epidemiology

and
Statistics
Nermin Mahmoud Ghith
B.S., PGDip.TQM, C.P.H.Q
Healthcare Quality Consultant
Nermin_ghith@hotmail.com
 Scientific Approach

Scientific process vs. quality improvement

process
Collaborative problem solving
Integrate data & information into research
Epidemiological theory
Roles of epidemiologist
 Planning

Design

Measurement

Measurement

Analysis

Improvement
 Accumulate & organize knowledge
Data, structure, values, & relationships
Use rating scales & indices
Quantifying information; summarizing &
comparing data
Studying chronic diseases by statistical
comparisons from observations of events
Refining statistical procedures
Assessment of probabilities & statistics
Studying long term outcomes
Conducting research involving cause &
effect studies, process evaluations,
descriptive studies
Delineating risk factors in study of disease
processes & prevention
 Improvement Projects Versus Research
Studies -- In general, improvement projects
should rely on scientific evidence from
clinical research reported in the peer-
reviewed literature, consensus that has
already been developed, and, where
possible, guidelines that have already been
written.
Carrying out improvement projects may
involve applying the results of research
studies and may utilize many of the tools and
terminology of epidemiological, clinical, or
health services research.
However, they should not involve:
Efforts to prove that a process of care is
effective or ineffective; or
Development of practice guidelines.
 Epidemiological Theory And
Methods
Definitions Of Epidemiology
The branch of medicine [and public health] that :
investigates the causes and control of
epidemics (prevalent and rapid-spreading,
human contagious disease)
All the elements contributing to the occurrence
or nonoccurrence of a disease in a population;
The ecology of a disease: the complex of
relationships between specific living organisms
and their environment.
 Definition By Avedis Donabedian

"The methodologically rigorous study of the

distribution of states of health and disease that
occur naturally in populations in order to infer
causation and plan remedial action.

Custodianship of the scientific method mainly

in population studies and particularly in clinical
settings. "
 Contributions Of Epidemiology
To Quality Management

Clinicians tend to think of quality one patient at

a time. Reviewers traditionally think of quality
case by case.
Epidemiology requires that evidence of quality
include descriptors of cohorts
(smokers/nonsmokers and lung cancer study)
or populations of similar patients.
 Contributions Of Epidemiology To
Quality Management
Specifying good practice
Specifying good system design
Distribution of quality among providers:
Distribution of quality among recipients of care
and populations at large; the
Developing measurement tools (precision in
measurement)
Criteria development;
Outcome measurement
States of health and ill health
 Contributions Of Epidemiology To
Quality Management

Comparative analysis of data:

Morbidity - Mortality
Causes of death
Diagnostic categorization
Indicators of disease states
 Contributions Of Epidemiology
To Quality Management

Designing and conducting measurement and

assessment
Quality control/measurement is a component of
epidemiological system design:
Identifying areas to measure
Observing process/performance
Documenting the effect on performance/process
of controlled changes in structure and operations
(Ql)
 Epidemiological Concepts And
Methods
Risk Factors: Associated with increased
danger of developing disease or condition
(untoward event);
Causality: Association between the occurrence
of an event and the outcome; the interrelation
of cause and effect; the principle that nothing
can exist or happen without a cause.
 Frequency Comparisons

Numerator and Denominator:

Numerator: The number (in a population) with a
disease, condition, or events.
Denominator: Either the number of the whole
population in the same place at the same time
(proportion) or a comparable population (ratio).
 Frequency Comparisons
Rate: A quantified (numerical)
comparison of the frequency of events
in one population (numerator) with the
frequency of the same events in a
comparable but different population
(denominator) in a specified time
period, expressed as whole number,
decimal, or percentage.
300 cancer treatments = 25 per week
twelve weeks
 Frequency Comparisons
Proportion (a part/whole relationship within
the same population
Part ( 3 surgical wound infections) = .05
Whole (60 surgical procedures performed)
Can be expressed in Decimal or Percentage:
A proportion is often called a 'rate" when it has
a designated time period, even though it is
using the same, rather than different,
population as denominator.
 Frequency Comparisons

Ratio: a fixed relationship between similar

measures-different populations, but a like or
similar unit of measure)
Expressed as:
- Fraction: 1 nurse per 8 patients ( 1/8)
- Colon: nurse/patient ratio of 1: 8
 Morbidity
The rate of disease or proportion of
diseased persons in a given locality,
nation, health system, etc.
Incidence: Rate during a specified time
period, e.g., during a one-year period:
# new cases of transfusion reaction
# of patients receiving blood
 Morbidity

Prevalence: Proportion in a defined

population, regardless of onset, calculated
at one specific point in time, e.g., on a
particular day (last day of May):
all infants immunized
total # eligible infant members in the
system
 Mortality
Mortality Rate:
The proportion of deaths in a population within a time
range.

deaths from auto accidents per year 80

total # of auto accidents per year 1000
=.08