Applying Epidemiology Studies to the HIM Classroom
ISSUES in Education
Applying Epidemiology Studies to the HIM Classroom
Epidemiology is the study of the distribution and determinants of disease in human populations. It strives to determine why some individuals develop a particular disease and others do not. Therefore, it looks for risk factors that may be linked with a particular disease and uses specific types of interventions to prevent the disease from occurring.
Normally, when epidemiology is taught in the classroom, it focuses on the clinical side and is usually taught with the needs of medical, nursing, dental and pharmacy students in mind. In these classroom settings, the basics of epidemiology are described and discussed and include the following: introduction and application of epidemiology, including time, place and persons; epidemiologic measures, such as incidence, prevalence, relative risk, survival analyses and case fatality; different types of epidemiological studies (descriptive, analytic, experimental); morbidity and mortality studies and statistics such as age adjustment; investigating the infectious disease outbreak using the incubation period, attack rate and risk ratio; examining tests of validity (sensitivity and specificity) and reliability (Kappa statistic) and examining types of bias; discussing the elements needed to establish a causal relationship; and throughout the course, reviewing and critiquing epidemiologic literature.
In teaching epidemiology to health information management (HIM) students, the content should be very similar to what is described above, but the instructor should provide unique examples that apply the use of epidemiologic principles to health information concepts. Developing these examples can be quite challenging because the literature in this area is new, and therefore, not as plentiful as clinical epidemiologic studies.
To enhance a basic epidemiology course and make it more specific to the needs of HIM students, several techniques can be used.
One method is to provide examples of published epidemiologic studies that have examined functions specific to health information. An example of one such study is by Hsia et al.1 The authors examined differences in coding accuracy after the enactment of the prospective payment system (PPS) and diagnosis-related groups (DRGs).
The impact this epidemiologic study and other coding accuracy studies have made on morbidity and mortality should also be discussed so that students understand the global importance of coding accuracy. When analytic studies—such as the case-control method–are described, examples of case-control studies specific to health information functions should be discussed.
For example, a case-control study performed by the author examined several risk factors that could potentially be related to ovarian cancer.2 What makes this study important to HIM professionals is that the author was also assessing whether the medical record was the most appropriate tool to use to collect the ovarian cancer and risk factor data.
Results demonstrated that the content of the medical record needed to improve before the record could be used as the primary data source in assessing risk factors related to ovarian cancer.
When infectious disease outbreaks, such as the food-borne outbreak, are described, exercises specific to the outbreak should be conducted with discussion centering around data needs for the prevention and control of infectious diseases. For example, in one exercise, students are provided lunch and given a written description of their illness and their specific symptoms. The objective of this exercise is to use epidemiologic principles (incubation period, attack rate, etc.) to determine the cause of the food-borne outbreak.
To do this, students develop a questionnaire using software called EPIINFO and then interview fellow students to determine if they became sick, their symptoms and the type of food they ate. Once the students determine the cause of the food-borne outbreak, discussion centers around the importance of infection control in a health care facility and how these same epidemiologic principles are used to prevent and control infections. Further discussion includes types of data one may need to collect and databases one may need to develop to better assess the cause of infections.
Other teaching exercises include redesigning quality assessment studies using epidemiologic principles. Because the quality assessment course is taught before the epidemiology course, students are required to redesign their quality assessment study using an epidemiologic study design.
For example, in one quality assessment project, the student assessed the quality of documentation on pediatric history and physical examinations within one health care facility.
If the student were to redesign this study using epidemiologic principles, comparison groups from other health care facilities could be used to determine differences in the quality of documentation. The student also could assess what risk poor quality documentation on history and physicals of pediatric patients had on their health outcomes.
Other methods used to apply epidemiologic principles to health information functions include requiring the student to develop an epidemiological research proposal based on some aspect of health information. For example, if the student is interested in assessing the cause of infant mortality in a specific geographical area, an additional focus of the proposal should include examining the accuracy of the data collected and recorded on the death certificate.
Methodology includes collecting data from both the death certificate and medical record to determine differences in demographic data, diagnoses, maternal risk factors and so forth.
Finally, throughout the epidemiology course, the instructor should provide the students hands-on analysis of electronic clinical and financial data in a database format. The students query the database to determine trends or patterns in the data and then determine the types of epidemiologic studies that could be performed based on the data queried. Progression from the very basic epidemiologic study (descriptive) to the very complex (experimental) should be described and discussed based on the data analyzed. Examples related to health information concepts should again be stressed and may include accurate DRG assignment, appropriate severity of illness scoring, trends in physician performance, clinical pathway agreement, and patient satisfaction analysis, just to name a few.
The primary goal in teaching epidemiology to HIM students is to enable the student to experience how the science of epidemiology fits into the science of health information. The best possible way to do this is to apply epidemiologic principles to health information concepts and functions. It may take some time to construct and develop exercises that meet this objective, but once it is accomplished the results are rewarding to both the student and instructor.
* About the author: Valerie J.M. Watzlaf is assistant professor, department of HIM, School of Health and Rehabilitation Sciences, at the University of Pittsburgh.
- Hsia D.C., Krushat M., Fagan A.B., Tebbutt J.A., Kusserow, R.P. “Accuracy of diagnostic coding for Medicare patients under the Prospective Payment System.” The New England Journal of Medicine. 318:352-355, 1988.
- Watzlaf, V. “Is the medical record an effective epidemiological data source?” Proceedings of the National Center for Health Statistics Public Health Conference on Records and Statistics, July 1989, pp. 57-60.