Healthcare Management Report: SCCS Model and Epidemiological Studies

This report examines the intervention of healthcare management issues through modified epidemiological studies, with a specific focus on the self-controlled case series (SCCS) model. The introduction highlights the importance of epidemiology in shaping healthcare policies and identifies morbidity and mortality as key social and demographic phenomena. The literature review discusses how epidemiological studies, such as those by Doll and Hill, have advanced medical understanding. It also explains the limitations of traditional studies and introduces the SCCS model as a valuable alternative. The report then delves into the renewed NHS health policy, emphasizing clinical management and awareness programs to curb morbidity. The SCCS model is explained in detail, including its application in analyzing transient exposures and outcomes. Two case studies are presented: one on detecting drug interactions between clopidogrel and PPIs and another on assessing vaccination response. A critical analysis of these reviews underscores the strengths of the SCCS model in healthcare management. The report concludes by summarizing the applications of SCCS and its impact on improving healthcare outcomes and informing policy.

INTERVENTION OF HEALTHCARE MANAGEMENT ISSUES WITH MODIFIED
EPIDEMIOLOGICAL STUDIES
Name of the Student
Name of the University
Author’s Note

1INTERVENTION OF HEALTHCARE MANAGEMENT ISSUES WITH MODIFIED EPIDEMIOLOGICAL STUDIES
Table of Contents
Introduction................................................................................................................................2
Literature Study on healthcare management issues...................................................................2
Health policy..............................................................................................................................4
The SCCS model on healthcare management issues.................................................................4
Applications of the SCCS healthcare management plan............................................................6
Two reviews of the SCCS model in curbing healthcare management issues............................6
i. Healthcare management to detect drug interaction of Clopidogrel and PPI.......................6
ii. Healthcare management to assess vaccination response....................................................7
Critical analysis of the two reviews of the SCCS healthcare management plan........................8
Conclusion..................................................................................................................................9
Bibliography.............................................................................................................................11

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Introduction
Epidemiology is the most vital keystone on which public health is based on. It is the
analysis and study of the health determinants and the distribution of disease conditions in a
defined population. It shapes the government policy decisions along with identifying risk
factors responsible for the cause of diseases. This knowledge helps in setting objectives for
preventive healthcare. Two most commonly studied social and demographic phenomena
include morbidity and mortality. Morbidity deals with the rate of presence of a particular
disease in a distinct population whereas mortality deals with the death caused due to that
particular disease (Johnson et al. 2014).
The structuring of healthcare policies, along with forming the frameworks for clinical
management plans, medical intervention programmes and designing strategies to control
morbidity and government supervision leads to prevention of the healthcare issue along with
decreasing adverse health outcomes (Koster et al. 2019).
Literature Study on healthcare management issues
Morbidity refers to the occurrence of unhealthy or diseased population. The frequency
of morbidity can be measured by two basic means, which includes determining incidence and
prevalence of the disease. Although the government has made substantial progress in
improving the health various still keeps challenging the overall health of the population. Even
though life expectancy has overall increased; however, rate of mortality is more or less
constant. The causes of death which are leading, ranked in the order of prevalence include
cardiac diseases; chronic lower respiratory diseases, malignant neoplasms, Alzheimer's
disease, cerebro-vascular diseases; diabetes mellitus, unintentional injuries, nephrosis (renal
disease); pneumonia and influenza; nephrotic syndrome nephritis and intentional self

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inflicting harm or suicide. These ten causes’ accounts for 75% of all deaths approximately, of
which seven are chronic diseases.
Epidemiological studies to related trends and patterns of various diseases was started
medically by Prof. Richard Doll and Dr. Austin Bradford Hill in 1951 who requested all the
registered doctors of United Kingdom is share the relevant patient information regarding
smoking habits and prevalence of different diseases amongst them (Doll and Hill 1954). This
research conducted by them was groundbreaking as it was the first successful
epidemiological study that demonstrated a potentially strong link between severity and
occurrence of various diseases and smoking. From that time onwards, frameworks for
epidemiological studies and their designing, along with structuring case-control studies has
been introduced in the medical management field so as to obtain information, design
strategies and plan programmes to generate awareness and organize medical interventions to
overcome such hurdles (Koster et al. 2019).
However, there are several scenarios where typical epidemiological studies fall short.
As for example, the research of undesirable and adverse effects of drugs might be difficult
and complex to recognize in a population or the data of the hospital might not have adequate
information while highlighting the precise catchment and points that require attention thereby
making it difficult to find suitable test subject along with relevant controls for the
epidemiological case study (Petersen et al. 2016). In these circumstances, the self controlled
case series (SCCS) protocol gives a design to investigate and evaluate association connecting
the test along with its outcome. As the SCCS technique is case only system which does not
require any separate control, it is convenient and easier to structure plans (Petersen et al.
2016).

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Health policy
The renewed modified health policy NHS England for 2019 highlights congregating
the demands of the patients along with providing aid to the care givers with the existing
techniques and medical management plans as to enhance the healthcare quality. The NHS
budget delivers the required finances so as to support improvement while incorporating
changes to address the Five Year Forward View health policy of NHS (NHS, 2019). The
Government also in support of NHS’s Five Year Forward view along with enhancing the
funding by £10 billion annually so as to improve the healthcare facilities (NHS, 2019).
NHS health policy emphasizes on the proper management of the clinical plans and
medical interventions along with promotion of awareness programmes for physical health
and mental care which can check the spread of morbidity thereby automatically reducing the
rate of mortality of the population (NHS, 2019). Strategies of checking the rate of morbidity
include reducing health inequality, improving efficiency and productivity of health care,
interventions for vaccination, promotion of healthy balanced diet, mental health well being
awareness, encouraging physical activity along with balanced diet, workout which have all
been accentuated in the NHS health policy.
The SCCS model on healthcare management issues
The self controlled case series (SCCS) of healthcare management as an modification
of the traditional epidemiological study involves designing protocol to collect data from
individuals who operate taking their own previous data as the control data therefore resulting
in data which can be compared within the individuals itself (Petersen et al. 2012). For this
reason individuals with experience in a particular disease or medical event are only included,
thereby eliminating difficult time invariant complications and lack of control data. The
chronological association of the transient exposure to the event is calculated with SCCS. This

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technique was initially used to evaluate vaccine safety, however with the profound success in
vaccine side effect analysis, it has been applied to a huge assortment of settings wherever the
exact size and population information is lacking or credentials of the comparison group is
complex (Petersen et al. 2012).
Figure 1: The figure is a pictorial depiction of the SCCS model (Petersen et al. 2012).
The figure 1 reveals the output of SCCS model highlights a individual, theoretically
exposed to a risk at two time points, with 2 identified periods of risk along with 5 age groups
recognized as panel A here. The individual observation points are divided into two exposure
risk periods illustrated as the red boxes and labeled as exposure risk status 1 along with five
age groups signified as the blue boxes and labeled as 0 to 4. The baseline groups for exposure
and age are age group 0 and in addition exposure risk status 0. The panel B of the figure 1
highlights the exposure related incidences which are statistically relative. The panel named C
is age related incidence on the age groups 1 to 4 when compared with the age group 0 while
the panel D highlights the age relative incidence for the age groups from 1 to 4 which have
been set to 2, 1.5, 1.2, and 0.5 along with the relative incidence of the overall profile.

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Applications of the SCCS healthcare management plan
The SCCS model is built on following the participants over the time period where the
exposure timeline which is fixed in addition with known and other events which are kept
random. The SCCS process lists the different experiences in that time frame and analyses it
based on the time before and after the event but within the specified time frame. The next
step involves setting up the framework to define the timelines and collect the data
accordingly along with sorting the timing of the risk exposure. The next step is setting the
timeframe within which the data will be gathered.
Healthcare management has issues in capturing adequate data on correct dosage.
Studies by means of SCCS might be able to emphasize on the multiple exposure risk periods
which is required to assess the healthcare management issue by analyzing the effect of
varying exposure effects or multiple doses or side affects risks. The division of the
observation period based on the age groups or the seasons is important to critically assess the
clinical management issue. The fourth step requires accurate mapping of the events based on
the risks and exposure which will thereby help in pointing out the healthcare management
issue and act on it accordingly.
Two reviews of the SCCS model in curbing healthcare management issues
The self controlled case series (SCCS) of healthcare management has been
successfully applied and reviewed. Two such reviews have been brought to light below.
i. Healthcare management to detect drug interaction of Clopidogrel and PPI
The health management issue of detecting of drug interaction was studied by Douglas
et al by using a cohort population study along with a SCCS model to study the interaction
clopidogrel with the proton pump inhibitors (PPI) and its effect on increasing the risk of

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myocardial infarction (Douglas et al., 2014). The normal epidemiological survey of the
population and analysis of the data generated showed an increase in the prevalence of cardiac
issues along with occurrence of the myocardial infarction as clopidogrel was ingested along
with the proton pump inhibitor (95%; Confidence Interval of 1.12 to 1.50 with relative
incidence of 1.30). However, exact effect or the time lapse between the ingestion of
clopidogrel ingestion and proton pump inhibitors was not reflected in the cohort study of the
population. This healthcare issue was then addressed by the SCCS model in précising the
time point along with suggesting the effect of the proton pump inhibitor in addition to
clopidogrel on the heart. The SCCS model evaluated if the possibility of myocardial
infarction was augmented during the period of the proton pump inhibitor addition to the
clopidogrel management. As a consequence of the clopidogrel treatment, the time period of
exposure to the proton ump inhibitors was extremely crucial which actually varied in length
amongst the participants and was finally highlighted by the SCCS model that no enhanced
risk was found for the myocardial infarction (0.75, 0.55 to 1.01) and was relevant with the
NHS healthcare policy.
ii. Healthcare management to assess vaccination response
The epidemiological modification based on SCCS model was done by Smeeth et al.
so as to analyse the connection between the inflammation and the myocardial infarction
(Smeeth, Thomas and Hall, 2015). The healthcare issue in prediction of stroke amongst
vaccinated and non vaccinated population is vital to make healthcare plans based on the
inflammatory stimuli and response to vaccinations along with acute infection and must be
concurrent with the NHS healthcare policy. The SCCS model was used to determine exact
population with the inflammatory response and myocardial infarction along with the accurate
information of the population. A greater than before risk of the myocardial infarction was
noted along with stroke was seen over risk period. The adverse effect was seen to amplify to

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about ninety days; however increased risk was not seen after vaccination with pneumococcal,
influenza, or tetanus vaccines. Therefore, the SCCS model helped in the healthcare
management issue of culpability of vaccination with increasing risks of inflammation and
myocardial infarction.
Critical analysis of the two reviews of the SCCS healthcare management
plan
The SCCS model for the management of healthcare issues focused on a modified
structure of standard epidemiological methodology to investigate relation between the
transient exposure of a given event and its outcome based on timeline mapping (Figure 2).
The main strength of SCCS model lies in the fact that it is a self controlled healthcare
management model and thereby accounts for all the parameters and factor which are
characteristic and controls are attainable and remains continuous over the entire time framed
designated as the observation period. Thus, the SCCS model provides a superior design along
with the convenience of generating control and experimental data and allows simple
designing of the experiment to easily investigate and analyze the healthcare management
issue. Examples of checking the rate of morbidity discussed in the report include reducing
health inequality, improving efficiency and productivity of health care, interventions for
vaccination, promotion of healthy balanced diet, mental health well being awareness,
encouraging physical activity along with balanced diet, workout which have all been
emphasized on in the NHS 2019 health policy of UK. This automatically helps in checking
the rate of mortality and therefore, keeping the population stable and healthy.

9INTERVENTION OF HEALTHCARE MANAGEMENT ISSUES WITH MODIFIED EPIDEMIOLOGICAL STUDIES
Figure 2: Statistical analysis of the two reviews of the SCCS healthcare management plan
(Source: Petersen et al. 2012).
Conclusion
Therefore, in the light of the above discussion, it can be concluded that rates of
morbidity and mortality of a defined population could be controlled with proper management
and government interventions. Strategies of checking the rate of morbidity include reducing

10INTERVENTION OF HEALTHCARE MANAGEMENT ISSUES WITH MODIFIED EPIDEMIOLOGICAL STUDIES
health inequality, improving efficiency and productivity of health care, interventions for
vaccination is crucial therefore models of healthcare management must be updated and
modified regularly to curb the epidemic of morbidity and mortality so as to improve the
health care system which will therefore lead to the improved quality of life. The SCCS or the
self controlled case series model is designed to deal with the healthcare management issues
and has been successfully reviewed by two epidemiological studies so as to assess drug
interaction along with addressing response to vaccination within a defined population and
over a designated time period and is also consistent with the healthcare policies termed by
NHS. Therefore, the SCCS model is ideal in dealing with healthcare management issues as
the model is self sufficient in generating its own set of control.

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Bibliography
Doll, R., & Hill, A. B. (1954). The mortality of doctors in relation to their smoking
habits. British medical journal, 1(4877), 1451.
Douglas, I.J., Evans, S.J., Hingorani, A.D., Grosso, A.M., Timmis, A., Hemingway, H. and
Smeeth, L., 2014. Clopidogrel and interaction with proton pump inhibitors: comparison
between cohort and within person study designs. Bmj, 345, p.e4388.
Handel, A., Li, Y., McKay, B., Pawelek, K. A., Zarnitsyna, V., & Antia, R. (2018). Exploring
the impact of inoculum dose on host immunity and morbidity to inform model-based vaccine
design. PLoS computational biology, 14(10), e1006505.
Johnson, N. B., Hayes, L. D., Brown, K., Hoo, E. C., & Ethier, K. A. (2014). CDC National
Health Report: leading causes of morbidity and mortality and associated behavioral risk and
protective factors—United States, 2005–2013
Koster, T.M., Wetterslev, J., Gluud, C., Jakobsen, J.C., Kaufmann, T., Eck, R.J., Koster, G.,
Hiemstra, B., van der Horst, I.C. and Keus, E., 2019. Apparently conclusive meta-analyses on
interventions in critical care may be inconclusive—a meta-epidemiological study. Journal of
clinical epidemiology, 114, pp.1-10.
Miller, K.L., Alfaro-Almagro, F., Bangerter, N.K., Thomas, D.L., Yacoub, E., Xu, J.,
Bartsch, A.J., Jbabdi, S., Sotiropoulos, S.N., Andersson, J.L. and Griffanti, L., 2016.
Multimodal population imaging in the UK Biobank prospective epidemiological
study. Nature neuroscience, 19(11), p.1523.

12INTERVENTION OF HEALTHCARE MANAGEMENT ISSUES WITH MODIFIED EPIDEMIOLOGICAL STUDIES
Nesterko, Y., Jäckle, D., Friedrich, M., Holzapfel, L. and Glaesmer, H., 2019. Prevalence of
post-traumatic stress disorder, depression and somatisation in recently arrived refugees in
Germany: an epidemiological study. Epidemiology and psychiatric sciences, pp.1-11.
NHS 2019. The Government’s revised mandate to NHS England for 2019. Department of
Health and Social Care. UK 2018-2019
Petersen, I., Douglas, I. and Whitaker, H., 2012. Self controlled case series methods: an
alternative to standard epidemiological study designs. bmj, 354, p.i4515.
Smeeth, L., Thomas, S.L. and Hall, H.J., 2015. Risk of myocardial infarction and stroke after
acute infection or vaccination. Journal of Vascular Surgery, 41(5), p.912.
Wu, Y.T., Fratiglioni, L., Matthews, F.E., Lobo, A., Breteler, M.M., Skoog, I. and Brayne,
C., 2016. Dementia in western Europe: epidemiological evidence and implications for policy
making. The Lancet Neurology, 15(1), pp.116-124.