Healthcare Quality Concepts Part 1 PDF

Quality Concepts The "appropriateness" of care is a. primarily a focus of utilization management. b. a key dimension of quality care. c. equivalent to "case management." d. the degree to which healthcare services are coherent & unbroken Janet - CH 1 - Concepts A medication is ordered for a diabe...

Quality Concepts The "appropriateness" of care is a. primarily a focus of utilization management. b. a key dimension of quality care. c. equivalent to "case management." d. the degree to which healthcare services are coherent & unbroken Janet - CH 1 - Concepts A medication is ordered for a diabetic patient. Its capacity to improve health status, as a dimension of quality or performance, is its a. effectiveness. b. potential. c. appropriateness. d. efficacy. Janet - CH 1 - Concepts That dimension of quality/performance that is dependent upon evaluation by the recipients and/or observers of care is a. respect/caring. b. safety. c. continuity. d. availability Janet - CH 1 - Concepts If in the continuous quality improvement process, we increase our emphasis on customer satisfaction and outcomes of care, which two dimensions of quality/performance must be incorporated into all quality management activities? a. Availability and respect/caring b. Respect/caring and competency c. Effectiveness and respect/caring d. Continuity and competency Janet - CH 1 - Concepts Which of the following key healthcare issues is more problematic for ambulatory care than for inpatient care? a. reimbursement for care b. access to specialty care c. appropriateness of treatment setting d. quality of care provided Janet - CH 1 - Concepts Incorporating TQM key concepts, compartmentalization of QM/QI activities by organizational structure, i.e., by department or discipline, is a. a weakness in implementing quality improvement. b. the most efficient structure. c. consistent with TQM philosophy. d. important for preservation of medical staff autonomy. Janet - CH 1 - Concepts One fundamental difference between monitoring product quality and service quality is based upon the fact that a. a service is easier to measure and verify in advance. b. a service is not perishable. c. a service is more heterogeneous than an object. d. there are more service delays than product delays. Janet - CH 1 - Concepts The quality professional can best facilitate the development of a “quality culture” in an organization by A. assessing the organization’s readiness to commit to change. B. designing a long range plane for cultural transformation. C. encouraging leaders to commit to a culture of excellence. D. leading the cultural transformation redesign team. Janet - CH 1 - Concepts The task of setting up an ambulatory care setting QM/QI program that focuses on "outcomes" as a measure of treatment effectiveness is difficult because a. the patient remains in control of treatment. b. patient care outcomes are determined by the payer. c. there are no required medical records. d. expected outcomes for ambulatory conditions are too obvious Janet - CH 1 - Concepts In developing a program to evaluate the effectiveness of physician care, a primary care clinic would select which one of the following indicators? a. The patients will express overall satisfaction with clinic facilities. b. The contract lab will provide results within 24 hours of sample delivery. c. The staff complies with all infection control policies and procedures. d. Newly diagnosed hypertensive patients are controlled within 6 months Janet - CH 1 - Concepts The Quality Management Cycle, based on Juran's Quality Trilogy (quality planning, quality control, quality improvement) a. excludes the lab's activities to monitor equipment. b. requires a departmentalized approach to quality management. c. encompasses only the nonclinical aspects of QM. d. incorporates information from strategic planning Janet - CH 1 - Concepts The perception of quality by a patient receiving care in an ambulatory healthcare center is influenced most by a. the physical environment. b. caring staff and physician. c. new technology. d. the physician's technical competence Janet - CH 1 - Concepts Total quality management philosophy assumes that a. most problems with service delivery result from systems difficulties b. frequent inspection is necessary to improve quality. c. most problems with service delivery result from difficulties with individuals. d. top management leadership in quality activities disenfranchises employees Janet - CH 1 - Concepts Outside the United States, most industrialized nations offer which type of healthcare insurance? a. Universal coverage b. Employer-based coverage c. Managed care d. Managed competition Janet - CH 1 - Concepts That function in the Juran’s Quality Management Cycle that includes the initial analysis of Data / information is a. quality planning. b. quality initiatives. c. quality control/measurement. d. quality improvement. Quality Control ➔ Initial Analysis Quality Improvement ➔ Intensive Analysis Janet - CH 1 - Concepts A potential conflict between the philosophy of total quality management and quality improvement in healthcare is the challenge in Deming's Principles to a. eliminate numerical goals for management. b. cease dependence on inspection. c. constantly improve every process. d. break down barriers between staff areas/departments Janet - CH 1 - Concepts The most basic components of managed care include all except a. prepaid financing. b. comprehensive services at multiple levels and settings. c. controlled access to services. d. broad choice of providers. Janet - CH 1 - Concepts What is the most important relationship between structure, process, and outcome as types of indicators of quality? a. Interdependent: Structure directly affects both process and outcome. b. Causal: Structure leads to process and process leads to outcome. c. Relational: Useful for comparisons, but not causal d. There is no relationship; they are categories used to group indicators. Janet - CH 1 - Concepts Physicians working with health maintenance organizations (HMOs) in the U.S. may be organized in any of the following models except [Not for CPHQ Exam] a. staff. b. network. c. broker. d. independent practice association Janet - CH 1 - Concepts Continuous quality improvement efforts find problems in hospital admission.To provide breakthrough ideas in admission , the quality team seeks ideas from : A. other hospitals B. previous lecture C. automobile industry C. hotel and resort industry Janet - CH 1 - Concepts Which of the following best describes the successful outcome of the quality improvement process? a. Customer satisfaction b. Enhanced communication c. Employee empowerment d. Improved statistical data Janet - CH 1 - Concepts Monitoring the specific organization and content requirements of a medical record system is a review of which focus? a. Outcome of care b. Process of care c. Structure of care d. Administration of care Janet - CH 1 - Concepts The major difference between traditional "quality assurance" activities and the expanded quality improvement/performance improvement activities is the QI/PI focus on a. people and competency. b. analysis of data. c. performance measures. d. systems and processes Janet - CH 1 - Concepts Monitoring phlebitis associated with IV insertions by nurses in the Surgical Intensive Care Unit addresses which focus? a. Outcome of care b. Process of care c. Structure of care d. Administrative procedure Janet - CH 1 - Concepts The centerpiece of "outcomes management" in healthcare is a. the measurement of the patient's functionality and quality of life. b. morbidity and mortality. c. data reliability. d. financial impact Janet - CH 1 - Concepts "Common causes" of problems in processes refer to a. one-time situations. b. temporary situations. c. acute situations. d. chronic situations Janet - CH 1 - Concepts Review of the timeliness of high risk screening for diabetes addresses which focus? a. Outcome of care b. Process of care c. Structure of care d. Administrative procedure Janet - CH 1 - Concepts The concept of risk management in U.S. healthcare [Not for CPHQ Exam] a. began in 1965 as a consequence of Medicare/Medicaid legislation. b. is in conflict with the goals of a seamless continuum of care and utilization management. c. permits an organization to ignore threats associated with increased corporate liability. d. developed as a result of increased physician malpractice liability costs. Janet - CH 1 - Concepts Under the quality improvement paradigm, which statement is incorrect? a. The focus is on the competency of individual practitioners. b. The focus is on the efficacy and effectiveness of processes. c. The focus is on the patient. d. The focus is on organization performance Janet - CH 1 - Concepts Within the context of total quality management philosophy, communication of quality is a. the responsibility of top management leaders. b. delegated to the Quality Management Department. c. an internal organizational, not community, issue. d. independent of process budgets or costs. Janet - CH 1 - Concepts The doctrine of "charitable immunity" or "innkeeper policy" for a healthcare provider organization has been replaced by [Not for CPHQ Exam] a. ostensible agency. b. "borrowed servant." c. corporate liability. d. tort liability. Janet - CH 1 - Concepts In managed care, the most common form of reimbursement for primary care physicians is a. straight salary. b. capitation without withholds. c. capitation with withholds. d. discounted fee-for-service. Janet - CH 1 - Concepts The probability that each step in a process will occur as it needs to occur is known as a. predictability. b. reliability. c. dependability. d. consistency Janet - CH 1 - Concepts A healthcare organization’s liability for the negligence of its employees is known as the doctrine of [Not for CPHQ Exam] a. respondeat superior. b. res ipsa loquitur. c. ostensible agency. d. quid pro quo. Janet - CH 1 - Concepts Organizational "culture" most often refers to a. the ethnicity of the organization's employees and licensed independent practitioners. b. assumptions about people and how work gets done. c. the efforts to reach out to the diverse groups in the community. d. the scheduled social and cultural events within the organization. Janet - CH 1 - Concepts Liability for the conduct of independent practitioners acting as representatives of the healthcare organization is known as [Not for CPHQ Exam] a. respondeat superior. b. duty of care. c. ostensible agency. d. tort liability Janet - CH 1 - Concepts Prospective payment systems provide reimbursement that is a. based on actual costs. b. based on charges. c. determined prior to care rendered. d. determined by the number of members served per year Janet - CH 1 - Concepts Applying the Pareto Principle in quality improvement is a. prioritizing process issues. b. tracking and measuring process effectiveness. c. providing meaningful data to support strategic objectives. d. prioritizing patient outcome issues. Janet - CH 1 - Concepts Special cause variation is to the process: a. random, extrinsic, outlier b. assignable, intrinsic, noise c. random, inlier, identifiable d. assignable, extrinsic, outlier Janet - CH 1 - Concepts "Managed competition" in healthcare most often refers to a. healthcare providers administered by competing management companies. b. healthcare providers competing by type of specialty. c. grouped healthcare providers competing within a geographic region. d. managed care organizations. Janet - CH 1 - Concepts The key goal of reengineering is to a. improve care processes. b. satisfy the customer. c. position for change. d. redesign the organization Janet - CH 1 - Concepts Steven Strong, 60, is recuperating from a total hip replacement procedure following a fall and fracture. He has a history of diabetes and heart disease and had an angioplasty just 2 months ago. He had been fully self-sufficient until the fall. The hospital has a new "Transitional Care Center" to which total joint replacement patients are transferred for postoperative physical therapy. The hospital is part of an integrated delivery system serving the community across the continuum of care. Use this information to answer questions I-41 and I-42: The integrated delivery system represents what type of healthcare system?. Subacute b. Horizontal c. Vertical d. Acute Janet - CH 1 - Concepts Steven Strong, 60, is recuperating from a total hip replacement procedure following a fall and fracture. He has a history of diabetes and heart disease and had an angioplasty just 2 months ago. He had been fully self-sufficient until the fall. The hospital has a new "Transitional Care Center" to which total joint replacement patients are transferred for postoperative physical therapy. The hospital is part of an integrated delivery system serving the community across the continuum of care. Use this information to answer questions I-41 and I-42: As part of the integrated delivery system, the Transitional Care Center will best meet Steve Strong's needs through a. case management b. continued physical therapy in the home c. diabetic disease management d. home evaluation through occupational therapy prior to discharge Janet - CH 1 - Concepts When common cause process variation is identified, the goal of quality improvement is to a. promote compliance with established procedure or protocol. b. eliminate the variation. c. improve practitioner competency. d. reduce variation sufficiently to produce stability Janet - CH 1 - Concepts In an inpatient stay, specific patient conditions that are present on admission and require treatment during the stay are called a. complications. b. comorbidities. c. community-acquired. d. healthcare-associated Janet - CH 1 - Concepts The interdisciplinary team is charged with creating a new admission process that will radically reduce current delays and wait times. The team is looking for a. continuous quality improvement b. systems thinking c. breakthrough improvement d. process reliability Janet - CH 1 - Concepts According to performance data, medications are not getting to patients in a timely manner. The front-line team has identified a five-step process and is intent on improving reliability. Use this information to answer questions I-46 and I-47 If the reliability rating for each of the steps in the process is 99%, 95%, 95%, 90%, and 93%, what is the probability of the entire process succeeding? a. 75% b. 80% c. 94% d. 95% Janet - CH 1 - Concepts According to performance data, medications are not getting to patients in a timely manner. The front-line team has identified a five-step process and is intent on improving reliability. Use this information to answer questions I-46 and I-47 Improvements are implemented and a performance measure is established for each of the five Steps in the process. The team is excited about the possibility of 100% reliability. One additional performance measure that would be best at measuring the goal would be a. # patients meeting one key step measure ÷ total # patients in sample b. # patients with all measures met ÷ total measures X # of patients c. total measures met ÷ total measures X # of patients d. # patients with all measures met ÷ total # patients in sample Janet - CH 1 - Concepts Surgical removal of the wrong body part is an example of [Not for CPHQ Exam] a. res gestae. b. non compos mentis. c. res ipsa loquitor. d. res judicata Janet - CH 1 - Concepts Healthcare quality professionals facilitating the assessment of the impact of the organization's culture on quality should evaluate, at the very least, the organization's degree of compliance with: a. the budget b. mission and vision statements c. the strategic plan d. policies and procedures Janet - CH 1 - Concepts Sunshine Community Medical Center is merging with three other hospitals and their IPAs and home health agencies to form the Sunshine Healthcare Network. The new integrated delivery system's vision is to create a seamless continuum of care within the region represented by their communities. The healthcare quality professional is part of a team working on the redesign of the quality management programs into an integrated systemwide quality strategy. Consider this scenario in answering questions I-50 through I-55 The systemwide merger and redesign best meets the definition of a. restructuring. b. rightsizing. c. downsizing. d. reengineering Janet - CH 1 - Concepts Sunshine Community Medical Center is merging with three other hospitals and their IPAs and home health agencies to form the Sunshine Healthcare Network. The new integrated delivery system's vision is to create a seamless continuum of care within the region represented by their communities. The healthcare quality professional is part of a team working on the redesign of the quality management programs into an integrated systemwide quality strategy. Consider this scenario in answering questions I-50 through I-55 The organizations involved in the redesign must each commit to a. preserving their culture. b. incremental change. c. fundamental change. d. their own leaders. Janet - CH 1 - Concepts Sunshine Community Medical Center is merging with three other hospitals and their IPAs and home health agencies to form the Sunshine Healthcare Network. The new integrated delivery system's vision is to create a seamless continuum of care within the region represented by their communities. The healthcare quality professional is part of a team working on the redesign of the quality management programs into an integrated systemwide quality strategy. Consider this scenario in answering questions I-50 through I-55 The success of the integrated quality strategy effort is dependent on the team's understanding of the need to a. include representatives from all current QI teams on the redesign team. b. implement one structure throughout the system. c. redesign QM processes in all the organizations. d. solicit input from all identified stakeholders. Janet - CH 1 - Concepts Sunshine Community Medical Center is merging with three other hospitals and their IPAs and home health agencies to form the Sunshine Healthcare Network. The new integrated delivery system's vision is to create a seamless continuum of care within the region represented by their communities. The healthcare quality professional is part of a team working on the redesign of the quality management programs into an integrated systemwide quality strategy. Consider this scenario in answering questions I-50 through I-55 To create a seamless continuum of care, the Sunshine Healthcare Network will first seek to a. consolidate locations b. integrate financial planning, information systems, marketing c. expand technology at all locations d. focus on incremental process improvements. Janet - CH 1 - Concepts Sunshine Community Medical Center is merging with three other hospitals and their IPAs and home health agencies to form the Sunshine Healthcare Network. The new integrated delivery system's vision is to create a seamless continuum of care within the region represented by their communities. The healthcare quality professional is part of a team working on the redesign of the quality management programs into an integrated systemwide quality strategy. Consider this scenario in answering questions I-50 through I-55 The key leadership skills needed for redesign efforts include a. communication, negotiation, systems thinking. b. communication, contracting, democratic style. c. planning, measurement, analysis. d. planning, finance, systems thinking.. Janet - CH 1 - Concepts Sunshine Community Medical Center is merging with three other hospitals and their IPAs and home health agencies to form the Sunshine Healthcare Network. The new integrated delivery system's vision is to create a seamless continuum of care within the region represented by their communities. The healthcare quality professional is part of a team working on the redesign of the quality management programs into an integrated systemwide quality strategy. Consider this scenario in answering questions I-50 through I-55 In an integrated delivery system, the success of the quality strategy is most dependent on the effectiveness of the a. information system. b. QI team process. c. case management process. d. patient care management system. Janet - CH 1 - Concepts In inpatient care, what is the key difference between a comorbidity and a complication: a. A comorbidity affects both treatment and length of stay. b. A complication is not present at time of admission. c. A complication is preventable. d. A comorbidity is not present at time of admission Janet - CH 1 - Concepts Oceanview Health System (OHS), consisting of two hospitals, long-term care, home health agency, and large multispecialty medical group, is beginning a reengineering effort due to a recent merger, decreasing reimbursement, and increasing operating costs. The leaders are committed to being a "learning organization" and to adopting a "systems thinking" philosophy, as a way to survive in the fastchanging healthcare marketplace. Use this information to answer questions I-57 and I-58 In evaluating their system's structure, OHS leaders must include a. bylaws, organizational chart, community assessment. b. budgets, process flows, quality improvement plan. c. locations, budgets, incentives. d. interrelationships, decisions, attitudes Janet - CH 1 - Concepts Oceanview Health System (OHS), consisting of two hospitals, long-term care, home health agency, and large multispecialty medical group, is beginning a reengineering effort due to a recent merger, decreasing reimbursement, and increasing operating costs. The leaders are committed to being a "learning organization" and to adopting a "systems thinking" philosophy, as a way to survive in the fastchanging healthcare marketplace. Use this information to answer questions I-57 and I-58 After first describing the problem, the best way to look at "patterns of behavior" over time is to use a. story telling and "The Five Whys." b. brainstorming and constructing gap hypotheses. c. line graphs and story telling. d. Pareto charts and brainstorming Janet - CH 1 - Concepts In statistical process control, it is important first to a. eliminate assignable causes of variation. b. eliminate random causes of variation. c. prioritize causes of variation. d. eliminate all causes of variation Janet - CH 1 - Concepts Sunshine Healthcare Network is trying to adapt to new contracting arrangements that will reduce applicable reimbursements by at least nine percent. In response, leaders approve a strategic initiative to redesign administrative processes, including all quality management/ improvement activities, in order to eliminate any unnecessary steps, forms, and staff responsibilities and become as efficient as possible. The philosophy that best supports this specific initiative is a. systems thinking. b. lean thinking. c. continuous quality improvement. d. reengineering. Janet - CH 1 - Concepts In the transition from quality assurance to quality management/quality improvement, which of the following emphases has resulted in the most significant benefit? a. Focusing primarily on process rather than individual performance b. Focusing on organization wide rather than clinical processes c. Organizing activities around patient flow rather than department or discipline d. Initiating more prospective rather than retrospective improvement efforts Janet - CH 1 - Concepts Your medical group is merging with a larger regional medical group. The functions of quality, utilization, and risk management will be centralized at the regional level, but expanded at the local level, necessitating changes in staffing, position descriptions, and processes. Such organizational change represents a. for-profit organizational structure b. downsizing c. a paradigm shift d. financial advantage Janet - CH 1 - Concepts Attempts to align the financial incentives of purchasers, payers, and providers with provider performance on clinical process and outcome measures could encourage a. underutilization. b. community backlash. c. overutilization. d. reengineering Janet - CH 1 - Concepts After defining "internal" and "external" customers, your organization is making a master-list of each type of customer before initiating a major change process. Of the following, which is the best next question to ask of staff? a. Who do you receive services from? b. Who in your work day do you serve? c. Which patients receive your services? d. How do you know a customer from a supplier? Janet - CH 1 - Concepts When incorporating lean thinking into process improvement, the quality professional teaches the team to a. identify suppliers and their inputs. b. focus on special cause variation. c. consider the system's structure. d. identify and eliminate wasteful steps Janet - CH 1 - Concepts Process indicator is defined as one that measures; A. Significant events that require further investigation B. An activity carried out to provide care or service C. Unexpected or negative variation D. The appropriateness of the procedure or treatment Janet - CH 1 - Concepts Performance Improvement data are used for credentialing and privilege-delineation. The practitioner is evaluated on his/her A. communication style and temperament. B. adherence to federal, state and organizational standards. C. cooperation, appropriateness, and staffing activities D. concern about the well-being of patients in long-term care Janet - CH 1 - Concepts The following is basically reviewed to determine the medical necessity and the appropriateness of service delivery in inpatient care: A. Admission review. B. Diagnosis-related group (DRG) validation. C. Procedure review. D. Quality audits Janet - CH 1 - Concepts The role of the Utilization Management include all except A. Care coordination and after care planning B. Review: medical necessity and appropriateness C. Resource allocation: timeliness, efficiency and cost Janet - CH 1 - Concepts When evaluating how many people in her facility's managed care plan were able to receive the flu shot. , under Dimensions of Performance A. appropriateness B. availability C. effectiveness D. efficacy Janet - CH 1 - Concepts Critical data selection elements for focused review of appendectomy surgeon : A) appropriateness - admitting symptoms - pathology results B) admitting diagnosis - pathology results - committee review C) preoperative testing - surgeon - admitting diagnosis - age D) LOS - diagnosis on admission - age – surgeon Janet - CH 1 - Concepts The most important patient safety issue to a utilization reviewer is a. timeliness of treatment. b. medical necessity for treatment. c. correct assignment of diagnosis or procedure code. d. appropriateness of healthcare setting. Janet - CH 1 - Concepts A radiology department regularly monitors x-ray repeat/reject, timeliness of report dictation, and patient waiting times. What component is missing in this department's ongoing evaluation program? A. Appropriateness review. B. Process evaluation. C. Quality control. D. Documentation analysis Janet - CH 1 - Concepts Zero waste in particular equipment, supplies, ideas and energy means: A. Effectiveness B. Efficiency C. Appropriateness D. Equity Zero Waste ➔ Resource ➔ Efficiency Janet - CH 1 - Concepts Appropriateness of appendectomy: A. preadmission test B. pathology test C. age D. Clinical test Janet - CH 1 - Concepts