Healthcare Public Health Assignment: Feedback Sheet 2023-24
Healthcare Public Health Assignment: Feedback Sheet 2023-24
MPH / HRM
Student ID number 2619637
Name of marker 1: Katherine Phillips
Name of marker 2: Leila Ghalichi
Using an epidemiological approach to needs assessment, estimate the annual need for diabetes education for T2DM in your population. Mark Max
Briefly explain what epidemiological data you will use to estimate need
Considered prevalence not incidence, did not consider undiagnosed cases. 5
Identify a source of epidemiological data and briefly explain why you think it is appropriate
Identified a few studies, some were more appropriate. The meta-analysis was maybe not as appropriate as it was prevalence. 5
Calculate the annual need for diabetes education
Applied figures to the population and came up with a sensible number. However, would have been more accurate to applied age and sex specific incidence rates 10
Estimate the annual number of hours of staff time that will be needed to deliver diabetes education
Calculation incorrect, did not take into account number in a group, unsure where 22 hours came from 5
Calculate the proportion those needing diabetes education who are male and female and the proportion who are aged 65 years. Explain how this information could be used to assess equity of service provision by age and sex.
Did not consider age specific rates, but good thoughts about equity 5
Total for this section 16 30
Using an epidemiological approach to needs assessment estimate the annual need for annual reviews for people with T2DM in your population Mark Max
Briefly explain what epidemiological data you will use to estimate need
Correctly identified prevalence 5
Identify a source of epidemiological data and briefly explain why you think it is appropriate
An epidemiological study eg of primary care diagnosed prevalence would have been more appropriate. 5
Determine the annual need for reviews
Plausible figure given, but age and sex specific figures would have given a more reliable figure 8
Estimate the annual number of hours of staff time that will be needed to deliver annual reviews
3 hours per year probably higher than needed. 2
Total for this section 12
20
Find and briefly appraise the evidence for structured diabetes education programmes for T2DM Mark Max
Briefly describe what you searched for and your search strategy
The question asked for an appraisal of evidence for education programmes, unclear why search was extended beyond this 10
Briefly appraise the strength of evidence in the most recent and relevant paper you identified
Paper chosen did not evaluate effect of education programmes. 10
Total for this section 3 20
One staff member is responsible for evaluating six centres delivering diabetes education for T2DM in your city Briefly explain what stage of evaluation this is, then identify and apply an appropriate evaluation framework
Appear to be suggesting evaluation of effectiveness, rather than ongoing operation of service 10
Specify what quantitative and qualitative data should be collected in relation to your chosen framework. The data collection should be practical given the number of staff available
Some appropriate data given, but maybe too much for one member of staff 10
Total for this section 8 20
Question about control chart Describe what is shown in the control chart. Write a short note explaining to the management whether you think introducing an incentive payment is a good approach. Suggest an alternative way to increase the proportion receiving all 9 checks.
Good discussion about the limitation of incentives Total for this section 6 10
College of Medical and Dental Sciences
ASSIGNMENT COVER SHEET 2023/24
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University of Birmingham Assessment and Feedback
The purpose of this template is to ensure you receive targeted feedback that will support your learning. It is a requirement that you complete all 3 sections, and to include the completed template as the first page of every assignment that is submitted for marking (your School will advise on exceptions).
STUDENT REFLECTIVE FEEDBACK
Section OneReflecting on the feedback that I have received on previous assessments, the following issues/topics have been identified as areas for improvement: (add 3 bullet points).
NB for your first assignment this may be from assessments in your previous institution or points you have picked up from the Introductory talks 1.
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Section TwoIn this assignment, I have attempted to act on previous feedback in the following ways (3 bullet points)
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Section ThreeFeedback on the following aspects of this assignment (i.e. content/style/approach) would be particularly helpful to me: (3 bullet points)
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Answer 1:____________________________________________________________________________
To estimate the annual need for diabetes education, I will primarily rely on the prevalence of T2DM in the population and the extent of newly diagnosed T2DM incidence. In addition, I will consider metrics of Age, Gender and Body mass index (BMI). Further, it is important to note additional metrics spanning Socio Economic Factors, Cultural Diversity and Comorbidities are needed to develop effective education and review programs.
I concur that a good potential source of epidemiological data is the national or regional health department. However, for the purpose of this task, I am choosing a meta analytical study: Prevalence of type 2 diabetes mellitus among inland residents in China (20002014) by (Yang, Lilly et.al, 2016). To establish a global average of the recently diagnosed T2DM prevalence, I have identified IDF Diabetes Atlas 9th Edition (2019), The Centers for Disease Control and Prevention (CDC) National Diabetes Statistics Report (2023) and Trends in diabetes incidence in the US, 1990-2014" (JAMA Internal Medicine, 2017).
The meta analysis by Yang, Lilly et.al presents and reviews epidemiological data based on age, gender and urbanisation and combines data from 77 different studies which validate the findings of the study concerning T2DM prevalence amongst large populations.The latter 3 studies have been identified to derive a valid global average of newly diagnosed T2DM patients, i.e. 2.5%.
The identified research material findings include the following
Prevalence increased rapidly with age, reaching 14.1% in the 65-74 age group.
Women (11.6%) had a slightly higher prevalence than men (9.9%).
Prevalence rate of T2Dm in the population is 9.1%.
Estimated T2DM cases = City population * Prevalence
Estimated T2DM cases = 1,000,000 * 9.1%
Estimated T2DM cases = 91,000
Given that annual need for education needs to be calculated for for all newly diagnosed individuals, we will calculate as follows:
Annual new diagnoses = Estimated T2DM cases * Annual new cases percentage (assumed 2.5%)
Annual new diagnoses = 91,000 * 2.5% (based on average estimation of newly diagnosed T2DM cases in developed countries)Annual new diagnoses = 2,275
Hence 2275 T2DM patients need an annual diabetes education program in my population.
Based on the value of 2275 newly diagnosed T2DM patients in my population, I will further refine this and consider that 20% of the population is either unavailable or has received the education. Hence:
Annual need for education coverage = 2,275 * (1 - 0.2) = 1,820 individuals
Annual Staff Time needed for the education program.
Based on a structured program of a 6-week group session (2 sessions/week) with individual consultations, we calculate:Staff time per participant = 22 hours (group sessions) + 0.5 hour consultation = 22.5 hours
Total staff time for initial education = 22.5 hours/participant * 1,820 participants = 40,950 hours
Total annual staff time = 40,950 hours (for newly diagnosed T2DM patients)
Notes - 1. Optimising the staffing model in various roles such as peer educators can reduce staff hours. 2. Online modules or by using mHealth apps we can reduce contact time and subsequent staffing hours.
As per T2Dm prevalence in the population:Males: 1,000,000 (population) * 0.099 [Prevalence estimations as per Lilly, Wang et.al, (2016)] = 99,000
Females: 1,000,000 (population) * 0.116 [Prevalence estimations as per Lilly, Wang et.al, (2016)] = 116,000
Population aged 65 years and above:
185,300 (population) * 0.141 [Prevalence estimations as per Lilly, Wang et.al, (2016)] = 26,108
Proportions:Males: 37.14%
Females: 43.51%
65 years: 9.85%
The information will help in assessing the equity of service provision in identifying disparities and improve the program planning routines and methods. If a specific group (say males aged 55-64) has a lower proportion needing education compared to their share in the general population, it suggests that they might be under-serviced in terms of educational services-receiving services. This creates a rationale that there could be a lack of awareness amongst this cohort or it may also suggest existence of entry barriers. Similarly the proportional figures can also highlight the over representation in the population which may determine a need for better coverage of health interventions within that group.The data also helps in improving education planning in terms of developing tailored programs for each cohort and judiciously allocating resources based on gender and age groups.
Answer 2_____________________________________________________________________________
To estimate the annual need for annual reviews for individuals with Type 2 Diabetes Mellitus (T2DM) in my population, I will primarily rely on epidemiological data related to the prevalence of T2DM within different age groups and genders. I will specifically use data that provides an intelligible classification of the number of individuals with T2DM in the given population, considering factors such as age, gender, and associated comorbidities.This epidemiological data will offer insights into the overall burden of T2DM in the community and allow us to calculate the percentage of individuals who require annual reviews based on established guidelines.
For the purpose of estimating the annual need for reviews, I have identified a systematic review and meta-analysis conducted by Dong, Chenyang et.al (2023). The paper provides valuable insights into the effectiveness of exercise interventions specifically tailored to real-life T2DM communities. Unlike many studies conducted in controlled environments such as hospitals or labs, this research considers the applicability of findings to everyday settings.The study includes randomised control trials (RCTs) and is quantitative assessment of how the interventions impact key indicators such as HbA1c, fasting glucose, 2-h plasma glucose, and Low-density lipoproteins levels; which are also key elements of my planned review.
To determine the annual need for reviews, I am taking estimated values from the identified source. Considering that all individuals with T2DM in my population require annual reviews, we quill first calculate the prevalence of T2DM in the population.
Prevalence of T2DM = Number of individuals with T2DM/ Total Population 100
= 0.081,000,000/1,000,000100=8%
Annual Need for Reviews = Prevalence of T2DM Total Population
= 0.081,000,000 = 80,000
To plan a structured diabetes review program amongst the T2DM populace, I will plan 3060 minutes per session, per week, for two months. This requires close collaboration with trained clinicians in evidence-based practices and ensuring adherence to the nine key parameters:
Biometric Assessments in form of routine screenings for HbA1c levels, blood pressure, and cholesterol during annual reviews and ensuring accessibility to reliable testing.
Integrate kidney function testing (Urinary Albumin and Serum Creatinine) into annual screenings.
Employ regular weight checks into annual follow-ups, offering counselling on diet and exercise.
Systematically assess smoking status during annual reviews.
Facilitate regular eye examinations through collaboration with eye care professionals.
Promote awareness and regular foot examinations to prevent complications.
Support the program with a digital data tracking system to monitor individual and population-level outcomes.
The review will take an average of 30 minutes to document the parameters specified in the question. Namely, Biometric Assessments Kidney Function Testing (Urinary Albumin and Serum Creatinine), Weight Checks and Counseling, Smoking Status Assessment, Eye Examinations, Foot Examinations and documenting the records in the digital management system or an open-source dashboard.
Calculation:
Total time per individual - 180 minutes (3 Hours)
Calculate the staffing hours T2DM patients (80,000) x 3 (Hours)=240,000 Staff Hours
Answer 3:______________________________________________________________________________
While conducting a systematic search for evidence on interventions and public health planning to addressType 2 Diabetes (T2DM), my focus extended beyond the term "education." I used keywords such as "T2DM management strategies," "glycaemic control interventions," and "patient outcomes in diabetes care" along with "public health education planning," "T2DM education programs," T2DM meta analysis and review and "epidemiological data on T2DM " were employed. I searched databases like PubMed, MEDLINE, and Cochrane for recent (within five years) and older systematic reviews and meta-analyses. My search focus was to identify different approaches beyond traditional public health programs where lifestyle modifications, therapeutic interventions, and patient care strategies were evidenced in the context of a large population and the studies consulted were conducted over a long period of time.
The recent study conducted by Dong et al. (2023) offered strong evidence regarding the positive impact of exercise interventions on glycemic control in individuals with diabetes. The study titled, Effect of exercise interventions based on family management or self-management on glycaemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis was recently published in November 2023 in the Diabetol Metab Syndr. The quantified findings of the study highlight a statistically significant reduction in glycated haemoglobin (HbA1c) levels among participants. The meta-analysis reveals a mean reduction of 0.8% in HbA1c levels, with a confidence interval of 95% ranging from 0.5% to 1.1%.
The research includes diverse regions to deduce global averages and outlook on T2DM epidemiology across different socio-economic contexts. While the study presents strong evidence to support the positive effects of exercise on glycemic control in diabetes, I concur that the absolute reliance on a meta-analysis may entail potential biases in the included trials. In other words, heterogeneity of interventions and participant characteristics may question the study findings as not applicable to the general population.
Answer 4___________________________________________________________________________
The given scenario of a staff member being responsible for evaluating six centres delivering diabetes education for T2DM represents the Program Evaluation of the stage to the milieu of implementing and monitoring the program activities.
I am recommending the National Evaluation Framework for Diabetes Self-Management Education and Support Programs (NDSS Framework) developed collaboratively by the American Diabetes Association (ADA) and the National Diabetes Services Society (NDSS), It is an effective tool to evaluate diabetes education programs and reviews.
The NDSS Framework provides criteria for examining the curriculum of diabetes awareness programs with evidence-based information on managing Type 2 Diabetes (T2DM). The framework includes standards for assessing staff qualifications, expertise, and training needs. The NDSS framework further offers a standard of procedure to measure satisfaction, engagement, and perceived improvements to comprehensively understand the program's impact on individuals with T2DM.
I have particularly chosen this as the framework allows the staff member to systematically evaluate the curriculum, staff training and health outcomes and adheres to the nationally recognized standards for optimising the public health outcomes in the city.
Both quantitative and qualitative data can be collected using the NDSS Framework. For curriculum evaluation, the framework uses surveys to get numerical ratings on how relevant the educational content is. It employs knowledge assessments to measure participants' understanding of managing Type 2 Diabetes. Within the framework, we can collect data on staff qualifications and the staff-to-participant ratio during sessions. Quantitative surveys in the framework are aimed at measuring participant satisfaction, and attendance records. To collect metrics on health outcomes, the framework advises to collect biometric data on glycemic control and track complications through health records. Qualitatively, the method documents focus group discussions, staff interviews, participant feedback, in-depth interviews, and narrative analysis.
Answer 5_____________________________________________________________________________
The control chart shows the proportion of patients with type 2 diabetes (T2DM) who receive all nine recommended annual checks in 100 general practices in the city of one million. Each circle represents the data for one practice. The horizontal line in the middle of the chart represents the average proportion of patients across all practices who receive all nine checks. The upper and lower control limits are represented by the dashed lines above and below the average line. The control chart shows that the proportion of patients who receive all nine checks are from about 40% to 100% which is an unusually large range. This suggests that there is a lot of variation in how different practices deliver diabetes care. It also shows that there are a few practices that are outliers. These are the practices that fall outside the control limits. The practice at P38, for example, has a much lower proportion of patients who receive all nine checks than the other practices. This could be due to a number of factors, such as the practice's patient population, the way the practice delivers care, or the way the data was collected.
Note to Management
On the subject of introducing a financial incentive for practices exceeding 70% coverage might seem a good resolution, however, I urge caution before implementing this approach.
While financial incentives can sometimes drive short-term improvements, they often carry unintended consequences. In the context of diabetes care, focusing solely on achieving a numerical target could lead to practices prioritising high-achieving patients where they will habitually focus their efforts on patients most likely to complete all checks. This may lead to rampant neglect towards patients with urgent needs or lower motivation. Resultantly, it will de facto widen the disparity and is fundamentally against the principles of health equity.
Another adverse impact of incentivizing the practice is the possible gamification or manipulation of the system. Gaming the system simply means that practices may resort to questionable strategies to inflate their numbers, such as selectively excluding challenging patients or compromising on checkup compliances, which would ultimately beat the very purpose of the program.
Healthcare as we all now cannot be a zero sum game and therefore, I am recommending to initiate an internal discourse on elevating the inherent motivation of practices. However, I consider the approach of empowering patients to take charge of their own health and take ownership for their active participation in the care plan. My direct recommendation to resolve the issue of a disparity in the chart is to establish a platform for peer-to-peer learning and knowledge exchange between high-performing and struggling practices under the supervisory purview of the City Health Department. This will allow successful strategies to organically spread and will curate an ecosystem for continuous improvement.
Thank you for your consideration. I remain committed to working with you to find the most effective solutions for improving T2DM care for all our citizens.
(end of note)
Assignment: health care public health
You work in a developed country which provides publicly-funded health care, with universal access to free primary care. You have been asked to plan services for people with Type 2 Diabetes (T2DM) in a city with a population of 1 million. The population structure is shown in REF _Ref86761831 h Table 1.
Table 1: Population of the region for which you are responsible
Age group Population structure
Males Females
0-15 97,200 92,500
16-24 54,000 51,000
25-34 67,800 66,500
35-44 63,000 64,000
45-54 66,000 68,000
55-64 61,200 63,500
65-74 48,200 52,000
75-84 28,200 34,000
85+ 8,800 14,100
All ages 494,400 505,600
Total 1,000,000
Recommendations for the care of people with T2DM
There are a number of recommendations for the care of people with T2DM.
All people newly diagnosed with T2DM should be offered and ideally attend a structured diabetes education programme.
All people with T2DM should be reviewed by an appropriately trained clinician at least once a year and receive nine care processes:
Blood glucose level measurement (HbA1c)
Blood pressure measurement
Cholesterol check
Kidney function testing (Urinary albumin)
Kidney function testing (Serum creatinine)
Weight check
Smoking status
Eye examinations
Foot examinations
Using an epidemiological approach to needs assessment, estimate the annual need for diabetes education for T2DM in your population.
Briefly explain what epidemiological data you will use to estimate need[5marks]
Identify a source of epidemiological data and briefly explain why you think it is appropriate[5marks]
Calculate the annual need for diabetes education[10marks]
Estimate the annual number of hours of staff time that will be needed to deliver diabetes education[5marks]
Calculate the proportion those needing diabetes education who are male and female and the proportion who are aged 65 years. Explain how this information could be used to assess equity of service provision by age and sex.[5marks]
Marks (30%)
Up to 500 words
Using an epidemiological approach to needs assessment estimate the annual need for annual reviews for people with T2DM in your population
Briefly explain what epidemiological data you will use to estimate need[5marks]
Identify a source of epidemiological data and briefly explain why you think it is appropriate[5marks]
Determine the annual need for reviews[8marks]
Estimate the annual number of hours of staff time that will be needed to deliver annual reviews[2marks]
Marks (20%)
Up to 400 words
Find and briefly appraise the evidence for structured diabetes education programmes for T2DM
Briefly describe what you searched for and your search strategy[10marks]
Briefly appraise the strength of evidence in the most recent and relevant paper you identified[10marks]
Marks (20%)
Up to 400 words
One staff member is responsible for evaluating six centres delivering diabetes education for T2DM in your city
Briefly explain what stage of evaluation this is, then identify and apply an appropriate evaluation framework[10marks]
Specify what quantitative and qualitative data should be collected in relation to your chosen framework. The data collection should be practical given the number of staff available[10marks]
Marks (20%)
Up to 400 words
One hundred general practices deliver annual reviews of diabetes in your city of one million. Data are collected from these general practices on the proportion of T2DM patients who receive all 9 annual checks. The data are shown in the control chart. In order to increase the proportion reiving all 9 checks, the management team propose introducing a financial incentive for practices where more than 70% of T2DM patients receive all 9 checks.
Describe what is shown in the control chart. Write a short note explaining to the management whether you think introducing an incentive payment is a good approach. Suggest an alternative way to increase the proportion receiving all 9 checks.
Marks (10%)
Up to 100 words
