Domain 5 Practice Quiz: Quality Management
Which QI tool is described as "helps an improvement team generate and organize large amounts of information based upon natural relationships. It allows the ideas to determine the categories or groupings, rather than allowing pre-determined groupings to determine or constrain the generation of ideas"?
Affinity analysis
Hospitals must have a committee to oversee medical necessity reviews. The composition of the committee and manner of functioning is spelled out in the ____ regulations.
CMS
State and Federal regulations, as well as accreditation bodies, require facilities to have mechanisms in place to ensure that appropriate patient care and clinical information is exchanged when patients are referred, transferred or discharged in a health care facility. Which department in a health care organization is responsible for making sure information is exchanged?
Case management
What is the name of the diagram used to organize the causes or factors into categories which could explain a QI problem?
Cause and effect or "fishbone" diagram
Which of the following care management tools organizes, sequences, and times the major patient care activities and interventions of the entire interdisciplinary team for a particular diagnosis or procedure?
Clinical paths
What is the name of the organization which is the QIO for Medicare beneficiaries in Colorado?
Colorado Foundation for Medical Care (CFMC)
You are an HIM Director who has collected data to show the CFO the reasons why codes are not being forwarded to the Billing Office within 3 days of discharge. Which QI tool could you use to illustrate the frequency of each potential cause?
Column or Bar graph
In 1996, a new data source used in credentialing staff in managed care organizations was mandated by HIPAA. What is the name of this source?
Health Integrity and Protection Data Bank (HIPDB)
Susan wants to use the PDCA Model with her HIM staff. What is the first step in the PDCA cycle?
Identify Improvement Opportunity
What is the primary source of information about adverse patient occurrences?
Incident report
Which guidelines use the Intensity-Severity-Discharge criteria for Acute care?
InterQual
Another name for the cause and effect diagram or fishbone diagram is the______________ diagram, named after its creator.
Ishikawa
For the purposes of assuring individual competence, physicians and other clinicians who are allowed by law to provide patient care services without direction or supervision and within the scope of their license are known as _________.
Licensed Independent Practitioners
Sharon is the HIM Director at Salisbury General Hospital. She feels there is a trend developing with the productivity of the transcriptionists. For each month over the last six months, two of the transcriptionists have steadily declined in their productivity. There has been no change in the third transcriptionist's productivity. What QI tool can Sharon use to plot the data and illustrate this trend?
Line or run chart
Which of the care guidelines are evidence based clinical guidelines, comparing what is actually happening to what could be happening under optimal circumstances for the average patient?
Milliman
Which organization is responsible for credentialing managed care organizations (MCOs)?
NCQA (National Committee for Quality Assurance)
Health care facilities are required by federal law to obtain a report concerning each Medical Staff applicant from the _______.
National Practitioners Data Bank (NPDB)
What is the name of the MAC for Colorado? The MAC performs the bill processing and benefit payment function for both Part A and Part B of the Medicare program.
Novitas Solutions
What is the name of the performance measurement initiative of the Joint Commission on Accreditation of Healthcare Organizations which required hospitals to collect data on standardized (or core) performance measures?
ORYX
Which resource management activity represents a growing area of research in medicine? The three steps are: define the ideal process, operationalize the ideal process and analyze the effect.
Outcomes management
Which QI process is described as "scientific methodology in which improvements are planned, tried, and checked to see if they deserve to be implemented or abandoned?" It can be repeated over and over for continuous improvement.
PDCA (Plan-Do-Check-Act)
Which QI tool is described as "a vertical bar graph showing the bars in order of size from left to right and a trend line showing the cumulative frequency of each value; this diagram helps people to focus on the "vital few" rather than the trivial many"?
Pareto Chart
Which term listed below describes when physicians evaluate and critique the medical decision-making and quality of care provided by other physicians?
Peer Review
______________ in the Pay For Performance systems have gone from measuring quality to now focusing on outcomes, cost efficiency and information technology. Choose the best answer.
Performance measures
Terri plans to write a PM which will measure whether 95% of the discharged charts are coded with less than 2% errors. What type of PM(s) does this represent?
Process or Outcome
What type of review might be triggered by claims that appear to exceed established norms?
Retrospective review
When using InterQual criteria, which set of criteria is used for the purpose of justifying admission to a hospital?
Severity of Illness (S.I.)
Case managers are typically assigned to individuals with complex care coordination needs. Which of the following describes such a need?
Spinal cord injury, several years old, requiring frequent hospitalizations for urinary tract infections
Larry wrote the following PM: Are there 1.5 FTEs for every 100 discharges per week? What type of PM is this?
Structure
What type of Performance Measure would be used to assess the adequacy of the number of computer monitors for the HIM staff?
Structure
Marcia was admitted to Denver Health for an elective surgery. The Admissions department overlooked the need to pre-certify the admission with Marcia's insurance company. What could be the result?
The insurance company could refuse to pay the bill.
Once the root causes of a problem are identified in a root cause analysis, what is the next step?
The team designs improvement actions called risk reduction strategies by the Joint Commission.
A "significant performance trend" is present when six, seven or more successive points show either a consistent increase or a consistent decrease in value (ignore points that repeat the preceding value.)
True
A run chart is a graph used to display performance measurement results over a specific period of time to identify trends or patterns.
True
A storyboard is a system developed in which characters, plots, locations, steps of a process, etc. are visually depicted by putting them on cards and reorganized to create new story lines. It is now used to illustrate the steps of a PI project.
True
A vertical line chart is the best tool to use to show data points consistently "moving" either upward or downward from the mean.
True
Control charts graphically depict variation inherent in a process (common cause) and variation arising from sources that come and go unpredictably (special cause variation.)
True
Core Measures are process and outcome measures of health care performance that are required by the Joint Commission as part of the accreditation process.
True
Events are considered potentially compensable when it is probable that the patient's injury or death could be attributed to acts of negligence by health care practitioners or other involved individuals.
True
Hospitals and LTC facilities cannot access information in the HIPDB.
True
Joint Commission standards require that all employees are provided general and specific training on patient safety hazards in their workplace and how to reduce risk of patient harm.
True
Peer review of a physician's performance by a physician outside the hospital, but in the same medical specialty, is known as an external review.
True
Rapid Cycle Improvement (RCI) is so called because the team focuses on small, concrete changes that can be quickly put into action in a pilot situation.
True
The author defines the major stakeholders in healthcare as providers, purchasers and consumers.
True
The presence of an event or situation that suggests the need for peer review is not an indication that the care provided was substandard.
True
There are three strategies the FMEA team can use for making a process safer. One of them is to identify failures quicker and take corrective action sooner.
True
In hospitals accredited by The Joint Commission, medical staff must conduct reviews on specific topics. The topics singled out for peer review in the 2009 standards include all but which one of the following?
Use of diagnostic MRIs
Which activity is one of the few requirements in Medicare regulations that are not also included in Joint Commission accreditation standards?
Utilization Management
Which of the following Resource Management activities is described by this statement: ________ includes utilization review and assessment/improvement of appropriate resource use."
Utilization management
What question(s) is/are asked during the FMEA?
What could go wrong? How badly could something go wrong? What needs to be done to prevent these types of failures? All of the above
Diagnoses which are targeted by Disease Management include all but which one of the following?
Wound caused by a dog bite
Dr. Marshall serves as the Director of the Quality Management Committee. He sent an email to Dr. Perkins regarding a case being reviewed in the QM Committee. In the email, Dr. Marshall shared he felt the attending physician had been negligent in her management of the patient. Dr. Perkins is NOT on the QM Committee. If this case goes to court, are Dr. Marshall's emails to Dr. Perkins discoverable?
Yes, by sharing information with another physician who is not on the QM Committee, the email became discoverable information.
The goal of six sigma is
defect free performance
The Six Sigma methodology employs the acronym, DMAIC, which stands for:
define, measure, analyze, improve and control
Joint Commission standards require formal employee performance appraisals must be done at least _______.
every three years
Which word means "future possibility of loss?"
exposure
What is the name of a systematic method for understanding competing forces that increase or decrease the likelihood of successfully reaching a desired outcome? This type of analysis forces people to think together about what works for and against implementing change, such as moving from a paper record to an electronic record system.
force field analysis
The Joint Commission accreditation standards suggest that organizations choose PMs for processes that are:
high volume high risk problem prone all of the above
Which type of flow chart maps out the process in terms of WHO is doing the steps?
matrix flow chart
Occurrence screens use a list of criteria to screen patients' medical records for occurrences that need closer examination. Examples of "occurrences" include all of the following EXCEPT
meals arriving 30 minutes late to the nursing unit
If a hospitalized patient develops what is considered by Medicare to be a preventable complication, no additional payment will be made to cover the added cost of caring for the complication. A preventable complication is often called a ______ event.
never
Which type of indicator is described as "a measure used to evaluate the results of health care services"? An example would be Percent of patients reportedly satisfied with the turn-around-time for Release of Information.
outcome
When the health plan conducts a prospective review, what activities are typically performed?
pre-admission certification (determination of the need for inpatient hospital care) prior authorization (coverage approval)
Which term describes the quality improvement tool needed when the team must make decisions among several options, often voting or using a decision matrix?
prioritization tool
Which type of indicator is described as "used to assess people's completion of tasks, whether the task was performed or not performed as expected"? An example in the HIM Department would be:Percent of medical records analyzed within 24 hours of discharge.
process
Which type of review occurs prior to the patient actually receiving services?
prospective
Joint Commission and other accreditation groups require facilities to have mechanisms to ensure that appropriate patient care and clinical information is exchanged when patients are __________. Choose the best answer.
referred transferred discharged all of the above
A method of determining medical necessity and/or appropriate billing practices for services, which have already been rendered, is a
retrospective review
What is the improvement model used for incident investigations following a significant mishap or sentinel event?
root cause analysis
Which QI process is described as "an investigation technique used following a sentinel event or other undesirable occurrence to identify the underlying issues that, if corrected, would reduce the likelihood of future similar events"?
root cause analysis
If the improvement team is investigating a potential relationship or correlation between two variables, then the _______ is the quantitative tool to use.
scatter diagram
What term is defined as "instability in performance results that would not be predicted by chance alone"?
special cause variation
Any group or individual who is affected by or who can affect the future of an organization is called a _________________.
stakeholder
Which type of indicator would be described as "a measure used to judge the adequacy of the organizational resources for delivering quality health care?" An example in the HIM department could be the ratio of HIM employees to the number of discharges each month.
structure
Complete this sentence: Events are called "sentinel" because:
they signal the need for immediate investigation and response
A Gantt chart is created first by defining a _______ across the top of the chart.
time line
When a hospital uses case reviews to evaluate physician performance, cases may be chosen based upon occurrences such as deaths, unusually long lengths of stay and unscheduled procedures. What can these occurrences be called?
trigger events
Medical staff are reappointed, including application and re-verification of information, every _______.
two years
Which of the following terms is defined as "improvement tool used to visually represent the movement of people, materials, paperwork or information within a process"? Choose the BEST answer.
workflow diagram
Lean thinking is based upon
zero waste concentration on improving value responding to the customer optimizing processes across the organization All of the above
All members of a QI or Performance Improvement team should be from one discipline.
False
By delegating the responsibility of competency evaluation to the Medical Staff, the governing board is no longer responsible for assuring competency.
False
In recent years, courts and juries only held companies liable for what they knew about an employee when they hired that person.
False
Incident reports are always incorporated into the patient's chart when the record is closed following discharge
False
Responsibilities and competencies of a position are included in a job description. Measurable standards of performance are not introduced until the employee's first evaluation.
False
The Joint Commission has specific standards related to assigning medical staff privileges and dictates exactly what that process must be.
False
The Milliman Care Guidelines and InterQual Criteria are non-proprietary, therefore, open to use by all providers.
False
The clinical pertinence review of the medical record is to evaluate the quality of care recorded.
False
Your health plan has direct access to your medical records, therefore they can make independent decisions regarding continued stay in a hospital without discussion with the hospital UR (Utilization review) department.
False
Components of disease management include all but one of the following. Which one does not belong?
Family counseling
According to B.W. Tuckman, there are four distinct stages that any team goes through in order to be productive. Which of the following lists those four stages?
Forming, Storming, Norming, Performing
A ____________ is used to estimate the time and resources required to implement each step of the action plan by creating a timeline across the top of the chart.
Gantt chart
In which of the following landmark decisions was the hospital found to be negligent if it knew or had a reason to know of a surgeon's incompetence?
Gonzales vs. Nork and Mercy Hospital
Which of the following is responsible for the quality of patient care and services provided by physicians and staff in a hospital?
Governing Board
_________ is the assessment of patient care services to ensure appropriate care, treatment, and level of care; performed while the patient is receiving services.
concurrent review
The FMEA project team selects the failures most in need of being prevented. What are these failures called?
critical failures
Which landmark decision expanded the hospital's liability to include responsibility for the actions of medical staff physicians and the nursing staff?
Darling vs. Charleston Community Hospital
What is the name of the proactive risk assessment methodology by which each potential failure mode in a system is analyzed to determine its effect on the process, the severity of each potential failure, causes of the failure, and the actions to be taken to repair the failure?
FMEA (Failure mode and effects analysis)
The Improvement and Modernization Act of 2003 required CMS to use _______ to identify underpayments and overpayments for services paid by Medicare Part A or Part B.
RACs (recovery audit contractor)
Despite protests to the contrary, the Medical Staff believes they are responsible for the quality of services at Ames County Hospital. The hospital's attorney is consulted. What is the outcome of this discussion? Choose the best answer.
Regardless of what the attorney says, the hospital's governing board is legally and morally responsible for the quality of services provided by physicians and staff.
