American Journal of Epidemiology Vol. 155, No. 6 : 580-581
Copyright © 2002 by The Johns Hopkins University School of Hygiene and Public Health
BOOK REVIEWS |
Epidemiology and the Delivery of Health Care Services: Methods and Applications, Second Edition
School of Public Health University of North Carolina Chapel Hill, NC 27599
Epidemiologists generally classify themselves into two groups: the common and conventional, or classical, group that studies the occurrence of disease and its risk factors; and the second group, less common and less conventional, which applies epidemiologic knowledge to the workings of health services. This book is concerned with the latter area, in which the authors illustrate the application of epidemiology to issues of health care, with special reference to the population perspective.
Health care services can be made to be responsive to the prevailing population conditions, such as fertility, diseases and deaths from certain conditions, and increases in the minority and elderly subgroups. Epidemiologic principles and methods are covered in the first part of the book, illustrative applications are covered in the second, and the third part is devoted to the interface of epidemiology with spanning topics. Each chapter is followed by several case examples to stimulate thinking about specific problems and possible solutions.
It is shown that epidemiologic indicators can be used to estimate needs and perceived health states and to identify the relation between need and demand. An analogy is drawn between "classic" or "etiologic" epidemiology and health services epidemiology by characterizing the features of a health care system, such as volume of service and type of care, as "exposure" factors. These factors have potential impact on population health states similar to that of risk factors on disease occurrence. Emphasizing a population perspective, epidemiology offers a set of tools and principles for the health care manager to monitor health states and to evaluate the impact of programs and, hence, form the scientific basis for policy formulation.
In the methods section, familiar epidemiologic measures such as incidence and validity are presented. A useful classification of health services and appropriate sources of data are also given. The use of epidemiologic and other data, such as aging of the population, in the planning of health services is illustrated. Similarly, the use of study designs in the evaluation of various services is highlighted.
The specialty area of management of health care quality draws heavily on epidemiology because the two have a common goal—improving the health status of the population. An example is the study of variations (geographic, ethnic, or gender related) in the receipt of health care procedures and their associations with outcome measures. Another example is the use of the scatter diagram in relating the number of physicians to health care procedures.
Another specialty area is the control of transmissible diseases, in which epidemiology provides a comprehensive understanding of the magnitude, causes, and consequences. The health care manager's responsibility varies according to the setting—hospital, nursing home, or hospice.
Management decisions are increasingly dependent upon having a working knowledge of genetic epidemiology—the third specialty area covered in this book. In this chapter, general and useful knowledge, including the potential contribution of the Human Genome Project, is well presented, but not much is offered on how this knowledge may be used by the health care manager.
The technology assessment chapter is rich with incorporating epidemiology into this important area. It is nice to see a presentation on meta-analysis, although it is somewhat curious that it is presented here rather than somewhere else in the book—in the methods section, for example.
The final specialty area highlights the challenges to the health care system of "environmentally provoked diseases." Environmental inequity, illustrated by the association of low income and poor housing, is another challenge. The chapter argues for considering the delivery of environmental health services within the broader context of the health care delivery system.
In the first spanning topic, epidemiology and the public policy process, the application of epidemiology to the formulation and evaluation of policies is illustrated. For example, a policy, aided by the national objectives of the Healthy People Initiative, can be designed to identify and eventually eliminate disparities in health states. Epidemiology may be further used to monitor and evaluate the effectiveness of intervention programs aimed at reducing such disparities.
Another spanning topic illustrates the use of epidemiologic information in economics, especially in modeling cost-benefit and effectiveness analyses. Epidemiologic data, especially with reference to population-based variables, including health outcomes, form the basis of such analyses.
The final topic, ethics, epidemiology, and health care delivery, is heavy on the principles of ethics generally with only a bit on its relation to epidemiology. Perhaps the emphasis here is on epidemiologic research because informed consent and confidentiality of patients' records are reviewed.
The book ends with reference to a host of web sites of several health care systems and a nice glossary. Health care managers as well as epidemiologists, whether classic or "nonclassic," will find this book a valuable addition to their reference shelf.
NOTES
ISBN 0-306-46525-6, Kluwer Academic/Plenum Publishers, New York, NY 10013-1578 (Telephone: 781-871-6600, Fax: 781-681-9045), 2001, 416 pp., $65.00
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