Bess TrevinoFor this discussion, I chose to identify national be

Bess Trevino
For this discussion, I chose to identify national benchmarks
related to preventive care. Since preventive care is the
foundation of value-based models and helps contain healthcare
costs, it is essential to focus on such benchmarks. Such
benchmarks are also crucial for addressing population-based
health, reaching Triple Aim goals, and meeting healthy people
goals.
One area where nationally we are at benchmark and have
exceeded the benchmark relates to blood cholesterol
measurements in adults in the last five years. The benchmark
goal was to have 82.3% of adults nationally. To date, adults
who have had a blood cholesterol test over the previous five
years are 89.5% (AHRQ, n.d). High blood cholesterol raises the
risk for heart disease, the leading cause of death, and stroke, the
fifth leading cause of death in the US (CDC c, 2021). 12% of
US adults over age 20 had cholesterol higher than 240mg/dL
(CDC c, 2021).
We are close to the benchmark to ensuring women ages 21-65
receive a PAP smear test in the last three years or the HPV
vaccine during the previous five years. For this category, the
benchmark is 84.2% of women in this age group to receive a
PAP smear. Nationally we are at 75.1% (AHRQ, n.d.). While
this is about 10% from reaching the goal, preventing cervical
cancer in women of all ages is critical. Cervical cancer deaths
have decreased in the US in the last 40 years, but it used to be
the leading cause of cancer death in women (CDCa, 2021). This
decline is associated with regular PAP smear screening. HPV is
the leading cause of cervical cancer.
Finally, we are far from the national benchmark to prevent
hospital admissions for hypertension in adults 18 and over. The

benchmark is 62.6%. Currently, we have achieved 19.1%
nationally. This is 227.7% below the benchmark. I chose this
benchmark because it is also part of the CDC’s 6|18 initiative
previously discussed in this course. One of the strategies to
achieve this goal is to improve care coordination using primary
care teams, standard protocols, and medication management
programs (CDCb, 2018).
A policy I suggest is to enlist a standard protocol for checking
blood pressure more frequently in high-risk adults 18 and over.
High blood pressure is diagnosed when systolic blood pressure
is consistently above 130 or diastolic BP is greater than 80.
Diagnoses usually require three measurements a week apart
(Fogoros, 2021). Other labs can determine if elevated BP is
either essential or secondary hypertension. Annual Well visits
should be conducted and are covered at no cost under all health
plans. The Well visit provides a prime opportunity for primary
care providers to address suspected high blood pressure. The
policy should require a month of blood pressure monitoring and
reporting. A small portable monitor can be sent home with
patients to capture weekly or biweekly BP for capable adults.
For patients unable to take their own BP, a home health program
should be utilized to check weekly or bi-weekly BP on patients.
A one month follow up exam would be required and should be
included at no cost to patients, and would initiate the labs-
blood (electrolytes, thyroid, blood glucose, BUN/Creatinine) or
urine(ketones, kidney failure, illegal substances) (Fogoros,
2021) to rule out secondary hypertension. If hypertension is
diagnosed, medication or lifestyle management can be initiated.
Policies that provide methods to diagnose and follow -up at no
cost to patients are integral for reaching this benchmark.
Agency for Healthcare Research and Quality (AHRQ). (n.d.)
.National quality
measures.https://nhqrnet.ahrq.gov/inhqrdr/National/benchmark/t
able/All_Measures/All_Topics#achieved

CDC a. (2021). Cervical cancer
statistics. https://www.cdc.gov/cancer/cervical/statistics/
CDC b. (2018). CDC’s 6|18 initiative. control high blood
pressure. https://www.cdc.gov/sixeighteen/bloodpressure/index.
htm
CDC c. (2021). High cholesterol
facts. https://www.cdc.gov/cholesterol/facts.htm
Fogoros, R. (2021). How hypertension is
diagnosed. https://www.verywellhealth.com/all-about-
hypertension-diagnosis-1746064
Ashlyn Rudd
Hello Everyone,
I decided to focus on the national diabetes quality measures.
The one area where we have nationally achieved the benchmark
or better is in the category of adults ages 40 and over who were
diagnosed with diabetes who had received at least two
hemoglobin A1c measurements in the last year. It was estimated
that it would be 74.3, which the benchmark being 79.5 meaning
we achieved within 6.5% of that estimate goal. (Agency for
Healthcare Research and Quality, n.d.).
One area where nationally we were close to the benchmark is in
the category of Adults who have a diagnosis of diabetes that had
their feet checked for any type of sores or irritation in the last
calendar year. The estimated percentage was 64.1, where we
were hoping about 84 % would do it. Sadly, we are deficient
23.7% in hitting the benchmark with is devastating because that
is how people we diabetes end up possibly losing their foot.
(Agency for Healthcare Research and Quality, n.d.).
Lastly, one area where we as a nation are far away from the
benchmark is in hospital admission for lower extremity
amputations per 1,000 population in adults with diabetes. The

estimated number is about 32.5%, with the benchmark being at
13.5%. That is a 140.0% difference which is crazy to me. Like I
said above, if patients do not check their own feet or have
someone else do it for them it could end in an amputation. As
you can see here it is more common than not, which saddens
me. (Agency for Healthcare Research and Quality, n.d.).
One policy that I think could move us closer to quality would be
making the patients follow up with their doctor once a year,
which they should already be doing, but at that appointment the
doctor should check the feet of the patient for any sores that are
not healing or any discoloration from damage to the feet and
even loss of circulation, as well as ask about any numbness or
tingling the patient might be experiencing. If this were on each
check-up the patient did with their doctor then maybe we could
increase the estimated number to be closer to the benchmark
that we hope for as a nation.
Reference:
National Healthcare Quality and Disparities Reports. NHQDR
Web Site - National Diabetes Benchmark Details. (n.d.).
Retrieved February 22, 2022,
from https://nhqrnet.ahrq.gov/inhqrdr/National/benchmark/table
/Diseases_and_Conditions/Diabetes#achieved
Jessica Fisher
The National Healthcare Quality and Disparities Report assesses
the performance of our healthcare system and identifies areas of
strengths and weaknesses, as well as disparities, for access to
healthcare and quality of healthcare. According to current
national quality measures we have achieved benchmark on
respiratory diseases and are close to benchmark on cancer
quality measures. However, we are far from benchmark on
quality measures related to mental health and substance use
disorder (Agency for Healthcare Research and Quality [AHRQ],
2021).

Because several of the measures are related to opioid substance
use disorders and overdoses, I think that passing of H.R. 2364 –
the Synthetic Opioid Danger Awareness Act, could help enact
legislative changes that could help us meet these quality
measures. In November 2021, the CDC announced that drug
overdose deaths in the United States had surpassed 100,000 per
year for the first time ever. Deaths due to opioids—mostly
synthetic opioids like fentanyl—accounted for more than 75%
of these deaths (Centers for Disease Control and Prevention
[CDC], 2021).
The Synthetic Opioid Danger Awareness Act legislation
requires the Centers for Disease Control and Prevention (CDC)
to implement a public education campaign related to synthetic
opioids, including fentanyl and its analogues. The legislation
also requires that the National Institute for Occupational Safety
and Health produce a training guide and webinar for first
responders and other individuals related to exposures to
synthetic opioids. Provisions mentioned in the legislation above
offer solutions to closing the substance use disorder treatment
gap and stopping SUDs before they start. According to the
American Psychiatric Association, in order to fully combat
SUDs, we must continue to work on legislation that increases
access and literacy, decreasing stigma, coordinates care, and
encourages everyone to work together to help patients and
communities recover from the impact that the opioid crisis has
had on our country (American Psychiatric Association [APA],
2021).
References
Agency for Healthcare Research and Quality. (2021, June).
National healthcare quality and disparities reports. AHRQ.
Retrieved February 22, 2022,
from https://nhqrnet.ahrq.gov/inhqrdr/National/topics/Diseases_

and_Conditions
American Psychiatric Association. (2021). APA letter to House
leadership requesting action on MH/SUD bills advanced by the
Energy & Commerce Committee [pdf].
file:///Users/jessicafisher/Downloads/APA-Letter-House-
Leadership-Energy-Commerce-MH-SUD-Bills-
08242021%20(2).pdf
Centers for Disease Control and Prevention. (2021, November
17). Drug Overdose Deaths in the U.S. Top 100,000 Annually.
CDC. Retrieved February 22, 2022,
from https://www.cdc.gov/nchs/pressroom/nchs_press_releases/
2021/20211117.htm
380 words
PermalinkShow parentReply
Melinda Pariser-Schmidt
On the area where we are far from benchmark, suggest a policy
to move us closer to Quality.
The National Healthcare Quality Disparities Reports documents
what “quality measures are compared to achievable benchmarks,
which are derived from the top-performing States” (NHQDR,
2022). “Low values are desirable for measures such as infant
mortality, whereas high values are desirable for measures such
as preventative screening” (NHQDR, 2022).
According to the National Healthcare Quality and Disparities
Reports we have reached benchmark for children ages 19-35
months who received 4 or more doses of diphtheria-tetanus-
pertussis vaccine, we are close to benchmark for infants born in
the calendar year who received breastfeeding exclusively
through 3 months, and we are far from benchmark for birth
trauma - injury to neonate per 1,000 selected live births.

The benchmark I’ve chosen to focus on for our “far from
benchmark” category is that we are far from benchmark for
birth trauma – injury to neonate per 1,000 selected live births.
These benchmarks are derived from the top-performing states
which means that even in the best case scenario we still fall
quite short of our goal. For this measure the graph shows us that
the benchmark is 2.8 / 1000 live births experience birth trauma-
injury to neonate, our performance lands us at 4.7/1000, putting
us approximately 64.7% shy of achieving the benchmark.
According to The National Vital Statistics Report birth injury is
defined as "an impairment of the neonate's body function or
structure due to an adverse event that occurred at birth"
(Dumpa, V., 2021). “These injuries include a wide range of
minor to major injuries due to various mechanical forces during
labor and delivery. Birth injuries are different from birth
defects or malformations and are often easily distinguishable
from congenital defects by a focused clinical assessment”
(Dumpa, V., 2021). Examples of birth trauma that are more
common may be cranial or peripheral nerve injuries, intracranial
hemorrhage, or fractures (such as clavicle or humerus during
difficult extraction). “A vital element in this context is the
prevention of birth trauma in the first place using an
interprofessional team involving obstetricians, neonatologists,
pediatricians, radiologists, and specialty trained nurses”
(Dumpa V. 2021). Collaboration and communication, along with
education, may help identify early risks, help parents make
informed decisions, and expeditiously carry out potential
interventions to prevent risk or injury. The table on the
breakdown of birth trauma – injury to neonate shows us that the
highest rates of birth trauma occurred in small, public, rural,
Community Access Hospitals (CAH) (NHQDR, 2021). Rural
Health Information Hub states “the CAH designation is
designed to reduce the financial vulnerability of rural hospitals
and improve access to healthcare by keeping essential services
in rural communities” (Rural Health Information Hub, 2022). To

me, this data points toward supporting a solution that includes
increasing opportunities for collaboration, communication, and
education in these settings. Thus, a policy that I would support
would be the Federal Office of Rural Health Policy’s National
Rural Health Policy Community, and Collaboration Program.
This program was slated to distribute funding to “identify,
engage, educate, and collaborate with rural stakeholders on
national rural health policy issues and promising practices in an
effort to improve the health of people living in rural
communities nationwide” (HRSA.gov., 2022). Though the
Federal Office of Rural Health Policy offers collaborative
policies and programs, another institution is also making strides
toward helping this demographic. The Centers for Medicare and
Medicaid Services has published a brief with aims of
“Improving Access to Maternal Health Care in Rural
Communities” (CMS, 2019). This brief states “CMS has aligned
health policies to its Rural Health Strategy and its new
Rethinking Rural Health Initiative, released its first Medicaid
and Children’s Health Insurance Program (CHIP) Scorecard to
evaluate state progress on maternal health outcomes, and is
preparing to implement the recently enacted Improving Access
to Maternity Care Act and Preventing Maternal Deaths Act. This
issue brief was developed by CMS to provide background
information on the scope of this problem and to focus attention
on the need for national, state, and community-based
organizations to collaborate on developing an action plan to
improve access to maternal health care and improve outcomes
for rural women and their babies” (CMS, 2019).
Support of the CMS Rethinking Rural Health Initiative and
Improving Access to Maternity Care Act, as well as any Federal
Office of Rural Health Policy measures which specifically
targets communication, collaboration, and education of the
maternal/fetal population, would likely provide great strides
toward improving our performance on the measure of birth
trauma – injury to neonate.

Citations:
Centers for Medicare & Medicaid Services. (2019, September
3). Improving Access to Maternal Health Care in Rural
Communities: Issues Brief. Retrieved February 2, 2022,
from https://www.cms.gov/About-CMS/Agency-
Information/OMH/equity-initiatives/rural-health/09032019-
Maternal-Health-Care-in-Rural-
Communities.pdf#:~:text=These%20innovative%20solutions%2
0include%20opportunities%20to%20improve%20access,scope%
20of%20practice%20laws%20for%20maternal%20health%20pro
viders
Dumpa, V. (2021, September 6). Birth trauma. StatPearls
[Internet]. Retrieved February 2, 2022,
from https://www.ncbi.nlm.nih.gov/books/NBK539831/
National Healthcare Quality and Disparities Reports. NHQDR
Web Site - National Benchmark Details. (n.d.). Retrieved
February 2, 2022,
from https://nhqrnet.ahrq.gov/inhqrdr/National/benchmark/table
/All_Measures/All_Topics#achieved
National Rural Health Policy, community, and collaboration
program. Official web site of the U.S. Health Resources &
Services Administration (HRSA). (2022, February 2). Retrieved
February 2, 2022, from https://www.hrsa.gov/grants/find-
funding/hrsa-19-021
Rural Health Information Hub. Critical Access Hospitals
(CAHs) Overview. (n.d.). Retrieved February 2, 2022,
from https://www.ruralhealthinfo.org/topics/critical-access-
hospitals#:~:text=Critical%20Access%20Hospital%20is%20a%2
0designation%20given%20to,hospital%20closures%20during%2
0the%201980s%20and%20early%201990s.

860 words
PermalinkShow parentReply
2/20/22, 3:35 AM Reflection 1
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35 1/2
Reflection 1
Due Sunday by 11:59pm Points 10 Submitting a file upload
(Turnitin enabled)
Available Feb 12 at 11:59pm - May 7 at 11:59pm 3 months
Start Assignment
PHIL. 134: COMPUTERS, ETHICS & SOCIETY
Kyle Yrigoyen
REFLECTION 1
In a short writing of roughly 500 words, please respond to the
following questions:
1. In your own words, what is philosophy? And, what is ethics?
Furthermore, what do you think is the
relationship to ethics in general and our use of computers in
particular? Why might this be important
to our society, from both your own perspective and that of

general society as a whole? Please be
sure to define your terms and give examples.
Grading
Write a short essay that addresses the questions above. When
you respond to these questions, you
should be specific and cite specific details from the class
readings and your own research. You may
provide references from your own research, but only in addition
to material provided by the course. Also,
you MUST make sure to cite your sources in your response and
include a reference list at the end of
your essay. Citations must be from reputable sources. Sites like
Wikipedia, about.com, etc. are NOT
considered acceptable sources.
Higher credit will be given for responses that show evidence of
a systematic and comprehensive
understanding of the topics involved.
Formatting
Standard font, preferably Arial in either 11pt or 12pt. Be sure to
structure your paper in proper paragraph
form. Do not write one, long run-on paragraph.
2/20/22, 3:35 AM Reflection 1
https://sjsu.instructure.com/courses/1478005/assignments/61009
35 2/2
MLA, APA, or any other format is acceptable provided that it is

consistent through the entire paper.
Please, no cover sheets.
INTRODUCTORY NOTES
WHAT IS PHILOSOPHY?
WHAT IS ETHICS (MORALITY)?
WHAT ETHICS IS NOT
WHAT IS PHILOSOPHY?
So, what is this thing called Philosophy anyway? We might
begin to answer that question by turning to
etymology, or the study of origins of words. Etymologically, the
word “philosophy” came to us from
Classical Greek, by way of the Greek Philosophers Socrates and
Plato. In this context, “philosophy”
means the lover of wisdom: a combination of “lover” (philia)
and “wisdom” (sophia). While the
designation “philosophy” originally meant to describe the
activities carried out by those men and
women who are lovers of wisdom, it has almost always included
the activities of systematically

questioning and critiquing the nature of thought itself. In other
words, philosophy might also be thought
of as the activity of thinking about thinking. As Stanford
philosopher David Hills says: “Philosophy is the
ungainly attempt to tackle questions that come naturally to
children, using methods that come naturally
to lawyers”.
Generally speaking, then, philosophy might be called the
critical investigation of thought thinking about
itself, or simply put, thinking about thinking. Traditionally,
philosophy has been identified with particular
historical figures and with the activities they performed or
principles by which they lived. By each of
these accounts, philosophy is then the love of wisdom, or as
some contemporaries would say, the love
of understanding. The 20th century philosopher Wilfrid Sellars
put it this way: the point of philosophy is
“to understand how things in the broadest possible sense of the
term hang together in the broadest
possible sense of the term”.
I want to suggest to you that philosophy is an activity, and that
as an activity, we are already doing
philosophy whether we are aware of it or not. I also want to
suggest that anything we can do is worth

doing well. If we look to gain a systematic understanding of
philosophy, it is helpful to distinguish
different domains of investigation that seek to ask and answer
different sorts of questions. So,
contemporary philosophy is often subdivided into five distinct
areas:
1. Metaphysics (including ontology)
2. Epistemology
3. Axiology
4. Social & Political Philosophy
5. Logic
1. Metaphysics (including ontology) investigates the
fundamental nature of existence, being,
counterfactuals, modality (possibility, necessity, contingency);
the mental and physical; space and time;
causation; free will; the existence or nonexitence of
supernatural beings or phenomena; mereology
(material constitution, heap paradox); change, and identity.

2. Epistemology investigates the domain of knowledge; what
knowledge is, what it isn’t; what is a belief;
justification; the structure of knowledge; the ultimate source of
knowledge; evidence, perception,
introspection, imagination, memory, reason, testimony;
skepticism and the limits of knowledge;
knowledge, wisdom, and understanding.
3. Axiology is the study of values; ethics and morality; the
nature of right and wrong; duty and
obligation; virtues; care; justice; beauty; moral responsibility;
metaethics; normative ethics; applied
ethics.
4. Social & Political Philosophy investigates the nature of
social and political institutions; the state and
the individual; the essence of government; social responsibility;
fairness; justice.
5. Logic is the study of argumentation; the nature of logical
consequence, necessity; of validity and
invalidity; inductive and deductive inference patterns; truth
preservation; formal systems; fallacies.
These five domains represent distinguishable areas of
investigation subsumed under the activity of
doing philosophy. Questions asked from within these domains

are often labeled first-order inquiries.
Second-order inquiries occur when questions from any of the
five domains are applied to other areas of
inquiry. So, for any given area of inquiry, we can investigate
that area with respect to philosophical
analysis, and adding the phrase “philosophy of”:
Area Second-order inquiries
Law philosophy of law
Science philosophy of science
Art philosophy of art
Technology philosophy of technology
Religion philosophy of religion
Computer Science philosophy of computation
WHAT IS ETHICS (MORALITY)?
Ethics is a branch of philosophy, under axiology (the study of
values).
Ethics can be defined as the study and application of standards
that distinguish between right and
wrong, good and bad. In this course, we will use the terms

‘ethics’ and ‘morals’ synonymously.
There are three branches of Ethics:
1. Applied Ethics
2. Normative Ethics
3. Metaethics
Applied Ethics
Applied Ethics studies ethical dilemmas, issues, and questions
as they arise in various practical or
professional contexts. Also called casuistry, Applied Ethics is
what we will be doing in this class, by
applying ethics to real cases.
Normative Ethics
Normative Ethics studies general theories and principles of
ethics that can be applied to practical
situations. The ethical theories we will use are normative
theories, or normative ethics. When you apply

Normative Ethics to cases, you are then doing Applied Ethics.
Rights Justice
Utilitarianism/Consequentialism Care Ethics
Deontology/Kantian Ethics Virtue Ethics
Metaethics
Metaethics studies the meaning of ethical concepts, theories,
and principles. When you study the
meaning of ethical concepts, you question the meaning and the
limitations of those concepts. You can
even question if there can be a good or complete ethical theory
at all.
Why study Applied Ethics?
It’s important to realize that Applied Ethics isn’t an exact
science, but that fact alone doesn’t imply
that doing Applied Ethics isn’t hard. Rather, it makes doing
Applied Ethics even more difficult.
This is because we have no singular agreement about which
ethical theory fits best in all cases. As a
branch of philosophy, a highlight of ethical analysis demands

that we use logic to make our ethical views
clearer in our own minds, and to have a strong voice when we
need to communicate important ethical
considerations. It is also a way for you to learn to reflect upon
and make explicit your own assumptions
about what values you hold to, and perhaps why you hold to the
values that you do. This is important
for every person who is to be considered educated, so that you
can make your own informed ethical
decisions. These are the skills this course is meant to provide.
WHAT ETHICS IS NOT
Ethics is closely related to law...
Laws are standards of conduct enforced by power of
government.
Laws usually reflect many of the moral values of society.
E.g., our society values honesty, so fraud is illegal.
Laws give us what a society holds as necessary rules of ethical
conduct.
E.g., we hold that murder, rape, etc. are wrong. We all believe
these actions are intolerable
behaviors. We believe that it is necessary to our society that

these acts not be allowed, and our
laws reflect this belief. The important point here is necessary
rules; rules that we feel are
ethically essential.
Laws can even change the moral values of a society.
...laws, however, are not ethics.
Often, rules of law are a minimum of ethical conduct.
E.g., we believe that identity theft is morally wrong but our
laws controlling identity theft and
protecting those who suffer identity theft are minimal.
Some actions may be legal but unethical...
E.g., Jim Crow Laws.
...some actions may be ethical but illegal.
E.g., When Rosa Parks refused to give up her seat on a public
bus.
Laws rarely go beyond the minimum, especially when laws
pertain to business, and most especially

when laws pertain to technology.
E.g., Technology is cutting edge, and often develops much
faster than governments can write
and pass laws. Technology is often many steps ahead of what
lawmakers know about
technology (Lawmakers are not usually trained in technical
fields).
Because of these factors, our laws give us minimum protection
from those who use technology
unethically. Of course, spamming and identity theft are two
very obvious examples of how laws lag
behind what we know to be unethical.
Ethics is not social code.
Here in the Bay Area we live alongside people from every race,
country, and religion. We learn tolerance
and we value tolerance. We believe that we should try to
understand people from other cultures. We
should not be too quick to morally judge other cultures. This
tolerance is important and ethical, but just
because we should not be too quick to judge others, this should
not mean that there is no universal
ethics, an ethics of all humanity.

Ethics is not mere social convention or custom.
ETHICAL RELATIVISM wrongly claims that Ethics is mere
social convention or custom, and that ethical
standards are relative to particular societies or cultures.
● Ethical Relativism does not allow for a global human culture,
and it fails to see that indeed there
is a global human culture.
● Ethical Relativism does not allow for ethical progress.
● Ethical Relativism does not allow for criticism of your own
culture and the ethical practices of
your culture.
Ethics is not minimal compliance with one’s Professional Code
of Ethics.
Here in the U.S. almost every profession now has a Professional
Code of Ethics.
● Not all rules of a professional code are moral rules.
● Sometimes the rules in professional codes are just
expediencies, designed to turn the most
profit.
● Some rules of professional codes might prove unethical in
some circumstances.

So, be aware: ethics should not be confused with the law, mere
social codes or customs, or professional
codes. Instead, it is the principles we can derive from the study
of ethics that provide the ethical
foundation for laws, social beliefs, and professional codes.
Sometimes the laws, social beliefs, or
professional codes do not stand up to what we know to be
ethical. We use moral reasoning to argue for
changes to laws, changes to social beliefs, and changes to
professional codes. So, do not use laws to
justify your ethical claims about a case. Do not claim that
something is ethical as stated by the
Constitution. Do not claim something is ethical because a law
says it is. In ethics, you are required to
prove that the law is ethical by explaining the ethics. You
cannot prove the ethics by appealing to a law.
As we learn to apply different ethical theories, some will be
obviously good fits in certain cases whereas
some will not. Over the course of the term, you will learn to
identify ethical principles as they arise in the
context of our subject matter, especially when it becomes
obvious that there are tensions between

competing ethical principles.
See discussions, stats, and author profiles for this publication
at: https://www.researchgate.net/publication/227591551
What Is Computer Ethics?
Article in Metaphilosophy · August 2007
DOI: 10.1111/j.1467-9973.1985.tb00173.x
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