Health Care Quality Improvement Final AL-367
Community Hospital has received a large number of claims denials for CT scans that were provided to patients. After review of the denied claims, the hospital has determined that clinical indications for the CT scan were not present. Which of the following reasons for claims denial does this scenario exemplify?
These scans did not meet medical necessity
Proper handwashing has been identified by the CDC as one of the single most important methods for preventing the spread of infection. Describe how healthcare organizations continue to educate staff to make hand washing a critical patient safety issue.
Chapter 10: evaluate the recommendations by the Centers for Disease Control and Prevention (CDC) on the complete program for healthcare organizations to continually maintain effective infection control practices.
Sites such as Hospital Compare use aggregated data to describe the experiences of unique types of patients with one or more aspects of their care. What is this data collection called?
Comparative
Which committee has a leadership role in the organization's medication safety efforts and consists of pharmacists, physicians, nurses, hospital administrators, and other healthcare professionals?
Pharmacy and therapeutics (P and T) Committee
Summarize the AHA's four key elements that affect the board's ability to carry out its PI responsibilities.
1)The board's understanding of the quality assessment and improvement system followed in the organization. 2) Adequate reporting to the board by the staff on specific performance measures. 3) The board's oversight and approval of the process to ensure the continued competence of physicians and other clinical and technical staff. 4) The board's active questioning of the information supplied on the quality of care provided in the organization through PI activities
This decision icon symbol is used in flowcharting to indicate __________.
A point in the process at which participants must evaluate the status of the process
Inappropriate timing of dose, transcription errors, missed doses, and extra doses given are all examples of this type of medication error __________.
Administration
As part of a large PI initiative that is occurring in the hospital, the PI team in charge of this initiative is tasked with presenting their findings to hospital administrators. The PI team presents data on the number of urinary tract infections (UTIs) that were documented and coded at the facility. The hospital administrators find this information interesting but are uncertain what the data means to the organization. Why are the hospital administrators unclear about this data?
Although the data provides important information regarding infections, the context of the data was missing from the presentation.
Which core process area is concern addressed for: social, spiritual, and cultural variables that influence the patient's and family members' perception of their lives?
Assessing the patient's needs
The act of granting approval for a healthcare organization to provide services to a specific group of beneficiaries is called __________.
Accreditation
The health information professional relies on the patient registrar to accurately identify the patient in the EHR this is an example of a(n) __________.
Customer expectation
A(n) _____ is an open-structure database that is not dedicated to the software of a particular vendor or data supplier, in which data from diverse sources are stored so that an integrated, multidisciplinary view of the data can be achieved.
Data repository
The chain of custody of a drug as it moves through the supply chain from manufacturer to pharmacy is called __________.
Drug pedigree
A Joint Commission-accredited organization must review their formulary annually to ensure a medication's continued __________.
Efficacy and safety
Community Hospital is changing electronic health record (EHR) vendors. This will be a significant change for the entire organization and will affect all departments and employees. Based on past experience from implementing their previous EHR system, the hospital administration knows it must get key employees from each department trained and on board with this new implementation in order for it to be successful. Which of Kotter's accelerators for change is administration using to build excitement and buy-in from employees for the new system?
Enlist a volunteer army
This medical staff standing committee is responsible for serving as a resource regarding medical and ethical issues that surface for patients, their families, and the organization's clinical care providers
Ethics committee
Care processes or interventions that developed from research performed on large population-based studies in order to achieve the best patient care outcomes are called __________.
Evidence-based medicine
Western States Medical Center is trying to determine how their instances of medication errors compare to other medical center of similar size in the region. They use available data to make this comparison and determine that their rate of medication errors is below the other medical centers in the region. What does this comparison exemplify?
External benchmarking
This component of a healthcare organization's infection surveillance program is responsible for documentation and tracking of follow-up procedures related to staff exposure to blood-borne pathogens:
Facility infection surveillance
Publicly reported data and information about nursing home quality of care is located on the nursing home compare website. This data is generated from the nursing home's __________.
Facility quality-indicator profile
Internal customers are individuals from outside the organization who receive products or services from within the organization.
False
Strategic planning may include a process called SWOT analysis where the leaders complete assessment of these four areas: strengths, weaknesses, opportunities, and tasks.
False
Which of the following techniques, used in unstructured interviews, helps the interviewer establish trust with the respondent and address the pertinent quality issues by moving questions from a broad theme to a narrow theme?
Funneling
Which of the following represents a list of potential blood-borne pathogens?
HIV and hepatitis B
When a hospital patient is diagnosed with one of the diseases from the health department's communicable disease list, who is responsible for notifying the health department?
Infection prevention and control team
Which of the following Joint Commission standards addresses how healthcare organizations must manage their information so that it can used to support high-quality and improved patient care?
Information management standards
CLIA and the CDC have established protocols for _____.
Laboratory departments
Bacteria of any kind that has become resistant to many different antibiotics is called __________.
MDROs
A patient is transferred from the critical access hospital (CAH) to the university medical center. The CAH sent a list of her current medications with the transfer documents. This list is then compared to the physician's admitting orders at the university hospital for consistency in order to provide continuity of care. This process is called __________.
Medication reconciliation
Discuss the two CMS Quality Payment Program options providers may choose from based on their practice size, specialty, location, or patient population.
Merit Based Incentive Payment System and Alternative Payment method. In MIPS, you may earn performance-based payment adjustments for the services you provide to Medicare patients. An APM is a customized payment approach developed by CMS, often designed to provide incentives to clinicians who are providing high-quality, high value care.
Elsie was admitted to Rosehill Nursing Facility for rehabilitation following her hip fracture. Upon admission to Rosehill, the nursing staff assessed Elsie in multiple areas, some of which are cognitive loss, mood, vision function, pain, and the medications she is taking. This information will be recorded in her health record for the __________.
Minimum data set to plan her care
The PI team at the local hospital was meeting today to discuss the PI initiative that they were working on. As the team began discussing the data collection process they were starting, John, a member of the team, interrupted and stated that he knew nothing about this data collection process. Since John missed that last PI team meeting, what tool could the team use to show John that he was informed on this data collection process even though he missed the previous meeting?
Minutes
The key to a healthcare organization's success is the coordination and cooperation of three groups that must work together to identify community needs and pursue organizational goals. These three groups include the governance, management, and employed staff. Governance of a healthcare organization is comprised of the board of directors and the _____.
Organized medical staff
Optimizing treatment of heart failure patients across the continuum of care to improve care and reduce hospital readmissions is an example of a(n) __________.
Outcome measure
Which of the following is a common standing committee in most healthcare organizations and is responsible for coordinating and reporting PI and safety activities?
PI and patient safety committee
Which type of data collection pertains to the care services provided to each patient?
Patient-specific
Findings from _____ are aggregated and reported to the executive committee of the medical staff as well as placed in clinician's professional files for consideration in the recredentialing process.
Peer review
Follow-up on a patient after discharge to ensure that the transition has gone smoothly and that the patient is receiving all of the services required is considered this case management step:
Postdischarge planning
This type of report is based on the documented meeting minutes and should include information about PI activities such as summaries of data collection, conclusions, and recommendations.
Quarterly report
How does the board of directors get informed of team-based PI activities in a healthcare organization?
See Chapter 6
Sacred Heart Nursing and Rehab Center has discovered that their satisfaction scores need improvement. Carol, the facility administrator, is looking for ways to improve these scores. What information must Carol understand in order to monitor and improve the satisfaction of her facility's residents?
See chapter 7.
How can continuity and coordination of care increase patient safety?
See chapter 8/9
Debbie is a risk manager at a local hospital. In order to reduce the risk of sentinel events occurring in her organization, she is using the lessons learned by other organizations regarding these events. To access details about sentinel events that have occurred at other facilities and recommended changes that may have prevented these events, Debbie utilizes which of the following?
Sentinel event alert
Which of the following is often used as a powerful tool of teaching and learning?
Storytelling
In this type of interview, a predetermined list of questions is used:
Structured interview
An HMO must understand the community in which it operates and determine the community's healthcare needs. Describe the process that the HMO uses to complete this evaluation.
They use community needs assessments and the HMO members, community members and community leaders compile the assessments. They gather the information for these assessments by analyzing who lives in the community, what resources are available to them, and what needs are needed.
Match the following adverse drug events to the type of error. 1. Prescribing Errors 2.. Pharmacy Errors 3. Administration Errors
Transcription Errors: 3 Medication errors related to transfer: 1 Missed doses: 3 Incomplete dispensing instructions: 2 Inappropriate dose recommendations: 2 Inappropriate dose: 1
A benefit from storytelling is that it documents team accomplishments over an extended period of time in an organized and succinct way.
True
API is a technology solution that allows software applications to share data in order to mine data in their information systems to improve patient outcomes.
True
The customer is the receiver of a product or service as a result of an organizational process.
True
The organization's leaders have a central role in initiating and maintaining the organization's PI priorities.
True
Which of the following is an integral component of case management that helps to improve patient outcomes and lower healthcare spending while still providing appropriate care to patients at the appropriate time?
Utilization review
Match the data to its data collection category: 1. Aggregated 2. Comparative 3. Patient-specific
__2__ Data on the hospital compare website __1__ Data on all patients with postoperative infections in the ICU __2__ Data found on HealthGrades __1__ Data on the number of hernia repairs performed with mesh __3__ Data about a sentinel event involving a 3-year-old patient
Match the following examples of hospital value-based purchasing program measures to their domain in the Medicare VBP program. 1. Safety 2. Person and community engagement 3. Clinical care 4. Efficiency and cost reduction
__2__HCAHPS Survey Results __4__ Heart failure 30-day mortality rate __1__ Catheter associated UTI __1__ Surgical site infection __3__ Medicare spending per beneficiary
Match the patient care situation to the appropriate core process in the patient care process cycle. 1. Assessing the patient's needs 2. Coordinating care, treatment, and services 3. Providing care, treatment, and services 4. Planning care, treatment and services
__4__Written plan for treatment is developed __3__Patient's status continuously monitored for signed of stabilization __1__Patient is assessed for issues related to legal or correctional status __2__Family or friends who will assist the patient at home following discharge
Match the following examples of hospital value-based purchasing program measures to their domain in the Medicare VBP program: 1. Safety 2. Person and community engagement 3. Clinical care 4. Efficiency and cost reduction
__?__ Catheter-associated UTI __?__ Surgical site infection __?__ Medicare spending per beneficiary __?__ Heart failure 30-day mortality rate __?__ HCAHPS Survey Results As part of the move to pay for value, CMS developed their value-based purchasing (VBP) program as part of the Affordable Care Act. This VBP program includes four domains: safety, clinical care, efficiency and cost reduction, and person and community engagement. Each domain includes a variety of measures that must be reported to CMS regularly.
Match the actions taken in regard to earthquakes to the type of planning activities: 1.Mitigation 2.Recovery 3.Preparedness 4.Response
__?__Have a building inspection __?__Place heavy objects on low shelves __?__Encourage staff preparedness at home through provision of home disaster information __?__Unplug nonessential equipment Once the top hazard vulnerabilities are identified, situational plans need to be developed for events such as utility failures, earthquakes, hurricanes, floods, tornadoes, and airline disasters. Emergency preparedness planning should be systematic and comprehensive. Planning should include activities that mitigate, prepare for, respond to, and provide recovery information from an emergency event.