Mixed Deck — All HAC Topics Flashcards

What is the primary purpose of 'propensity score matching' in observational patient outcome studies?

Answer: To reduce confounding by balancing treatment and control groups on observed covariates

Propensity score matching creates comparable treatment and control groups by matching patients on their probability of receiving treatment, reducing selection bias.

Net Monetary Benefit (NMB) is calculated as:

Answer: (Willingness-to-pay threshold × incremental QALYs) − incremental costs

NMB converts health outcomes to monetary units using the WTP threshold and subtracts incremental costs; positive NMB indicates cost-effectiveness.

Which approach to data integration is BEST suited for near-real-time analytics dashboards in a clinical setting?

Answer: Change data capture (CDC) with streaming pipelines

CDC captures row-level changes as they occur and streams them downstream, enabling near-real-time data freshness.

The Trusted Exchange Framework and Common Agreement (TEFCA) establishes rules for nationwide health information exchange. Which organization serves as the Recognized Coordinating Entity (RCE) under TEFCA?

Answer: The Sequoia Project

The Sequoia Project was designated as the RCE by ONC and is responsible for operationalizing TEFCA and onboarding Qualified Health Information Networks (QHINs).

A quality analyst finds that a critical lab result field is populated in only 60% of records. Which action should be taken FIRST?

Answer: Investigate whether missingness is random or systematically related to patient characteristics or workflow factors

Understanding the mechanism of missingness (MCAR, MAR, or MNAR) is essential before choosing any handling strategy.

Which standard framework specifically addresses electronic health information exchange security controls and is frequently referenced alongside HIPAA compliance programs?

Answer: NIST Cybersecurity Framework (CSF)

The NIST Cybersecurity Framework is widely adopted by healthcare organizations to supplement HIPAA Security Rule requirements and manage cybersecurity risk systematically.

Which approach best reduces selection bias when evaluating a population health intervention without a randomized control group?

Answer: Propensity score matching to create comparable intervention and comparison groups

Propensity score matching balances observed confounders between groups, approximating a randomized comparison in observational study designs.

Which regulatory framework most directly governs clinical decision support software that qualifies as a medical device in the US?

Answer: FDA 21st Century Cures Act provisions on software

The 21st Century Cures Act established criteria distinguishing non-device CDS software from software requiring FDA oversight as a medical device, based on its intended use and decision autonomy.

In healthcare supply chain analytics, what does 'par level' management involve?

Answer: Maintaining predetermined minimum inventory quantities to prevent stockouts without overstocking

Par level management sets threshold inventory quantities so supplies are reordered when stock falls to that level, balancing availability against carrying costs.

A healthcare intervention has an ICER of $45,000 per QALY. Using the US threshold of $50,000–$150,000 per QALY, this intervention is considered:

Answer: Cost-effective at the lower bound of the threshold

An ICER of $45,000/QALY falls below $50,000, making it cost-effective even at the most conservative US threshold.

In population health surveillance, what is the role of a sentinel surveillance system?

Answer: Monitoring a select group of sites to detect disease trends before widespread spread

Sentinel surveillance uses selected reporting sites to provide early signals of disease trends with less resource intensity than universal surveillance.

Extended dominance occurs when an intervention is ruled out because:

Answer: A combination of two other interventions produces better outcomes at lower cost

Extended dominance eliminates an option whose ICER is higher than that of a more effective alternative, making a linear combination preferable.

A pharmacy CDSS generates a drug-drug interaction alert between warfarin and a newly prescribed NSAID. The alert includes an alternative NSAID with lower bleeding risk. This type of alert is BEST classified as:

Answer: An interruptive alert with an actionable alternative

An interruptive alert with an actionable alternative both warns about a hazard and offers a clinician-ready substitute, which research shows significantly increases alert acceptance rates compared to warnings alone.

Federated learning is particularly valuable in healthcare because it:

Answer: Allows model training across institutions without sharing raw patient data

Federated learning trains models locally at each institution and shares only model updates, preserving patient privacy and complying with regulations like HIPAA.

What analytical challenge does 'small denominator instability' create in population health reporting?

Answer: Rate estimates for small subgroups are statistically unreliable and can fluctuate dramatically with few events

When a subgroup has very few members, even one or two events can cause the rate to swing widely, making the estimate unreliable for decision-making.

What does 'alert tiering' mean in CDSS design?

Answer: Categorizing alerts by severity so high-risk alerts are more interruptive than low-risk ones

Alert tiering assigns different interruption levels—such as hard stops, soft stops, or informational banners—based on clinical severity to reduce alert fatigue while preserving attention for critical warnings.

Which metadata element is MOST critical for assessing whether a dataset is appropriate for a specific analytics use case?

Answer: Data provenance, including source system, collection method, and time period covered

Provenance metadata describes data origins and collection context, which determines fitness for a particular analytical purpose.

A CDSS alert fires every time a clinician orders aspirin for any adult patient. This is an example of which alert quality problem?

Answer: Alert fatigue from low specificity

Low specificity causes alerts to fire too broadly, leading to alert fatigue when clinicians repeatedly override non-actionable notifications.

Which CMS program uses the Hierarchical Condition Category (HCC) risk adjustment model to calculate expected healthcare costs for Medicare Advantage beneficiaries?

Answer: Medicare Advantage (Part C) risk adjustment

CMS uses HCC risk scores to adjust Medicare Advantage plan payments based on the predicted health costs of enrolled beneficiaries.

A CDSS recommends antibiotic selection based on local antibiogram data. Which type of clinical knowledge does this primarily represent?

Answer: Population-level contextual knowledge

Local antibiogram data represents population-level contextual knowledge about regional pathogen resistance patterns that informs clinical decisions for individual patients.