Quality Final

"When an IT system alerts the physician to a potential incompatibility when a new drug is prescribed for a patient, how is the system helping to prevent mistakes?" A. Reducing inefficiencies B. Standardizing the process C. Making failures visible D. Mitigating harm

C. Making failures visible

What group requires managed care organizations to have a written utilization management plan? A. Centers for Medicare & Medicaid Services B. The Joint Commission C. National Committee for Quality Assurance D. Alliance of Community Health Plans

C. National Committee for Quality Assurance

What is an example of overuse of healthcare resources? A. Child admitted to the hospital for management of asthma B. Home-bound patient receives home health services following a stroke C. Physician prescribes antibiotics for a patient with a cold D. Emergency physician applies cast to patient s broken arm

C. Physician prescribes antibiotics to patient with a cold

The number of actions that achieve intended results divided by the total number of actions is measuring what aspect of performance? A. Effectiveness B. Compliance C. Reliability D. Satisfaction

C. Reliability

What is the purpose of population health care? A. To establish primary care clinics for persons in a defined population B. To drive down costs and healthcare inefficiencies in a defined population C. To maximize the health and well-being of persons in a defined population D. To create wellness incentives for persons in a defined population

C. To maximize the health and well-being of persons in a defined population

What membership requirements does Medicare impose on hospital utilization review committees? A. Committee must be chaired by the medical director B. One member must be a registered or licensed practical nurse C. Two members must be doctors of medicine or osteopathy D. Case manager members must be credentialed

C. Two members must be doctors of medicine or osteopathy

"According to The Joint Commission in 2015, which of the following was one of the most common root causes of sentinel events in healthcare organizations?" A. Complexity of healthcare delivery B. Failure of process safeguards C. Too few facilities with advanced information technology D. Inadequate communication between care providers

D. Inadequate communication between care providers

What are the three primary quality management activities? A. Quality planning, control, and improvement B. Goal setting, prioritization, and measurement C. Overuse, underuse, and misuse D. Measurement, assessment, and improvement

D. Measurement, Assessment, and Improvement

What federally recognized group maintains a database of adverse patient events? A. Quality Improvement Organization B. National Patient Safety Foundation C. Agency for Healthcare Research and Quality D. Patient Safety Organization

D. Patient Safety Organization

What healthcare reimbursement system rewards care providers for achieving cost performance expectations? A. Fee-for-service B. Standards of care C. Evidence-based medicine D. Pay for performance

D. Pay for Performance

What is a measure of the health status of people in a population? A. Percentage of population that is insured B. Percentage of unnecessary emergency department (ED) visits C. Percentage of adults who are satisfied with their lives D. Percentage of children aged 3-11 years exposed to secondhand smoke

D. Percentage of children 3-11 years exposed to second hand smoke

What is the Primary Purpose of risk management activities in a healthcare organization? A. Ensure Compliance with clinical practice guidelines B. Serve as an advisor to the governing board C. Coordinate customer service activities D. Protect the Organization from financial losses

D. Protect the Organization from financial losses

What technique can be used to minimize cognitive overload for hospital caregivers? A. Test staff competencies at least annually. B. Eliminate committee assignments. C. Add patient care decision aids. D. Provide staff with adequate off-work intervals.

D. Provide staff with adequate off-work intervals

During what stage of team development do team members often exhibit dissension, irritation over lack of progress, and general impatience? A. Forming B. Performing C.Norming D. Storming

D. Storming

What is an improvement action considered to be strong meaning it is more likely to achieve patient safety improvement goals than weak or intermediate actions? A. Software enhancements B. Checklists for staff to follow C. Process double-checks D. Tangible involvement by leadership

D. Tangible Involvement by leadership

When can an organization stop measuring the effectiveness of actions taken during an improvement project? A. After it is confirmed actions were implemented B. When data are no longer available C. When a higher priority for improvement is identified D. When people are confident the improvement is permanent

D. When people are confident the improvement is permanent

True or False? Accountable care is one of the healthcare quality characteristics identified as important by the Institute of Medicine in 2001.

False

True or False? Improvement initiatives are successful when it is expected that people will perfectly execute their job responsibilities.

False

True or False? Skilled nursing facilities often conduct concurrent reviews to determine whether a patient s condition warrants admission to the facility.

False

True or False? The American Medical Association discourages healthcare organizations from including consumers as members of patient safety advisory groups.

False

True or False? The Joint Commission accreditation manual includes a chapter that covers utilization management standards.

False

True or False? The Joint Commission requires accredited healthcare organizations to have a quality management plan?

False

True or False? The hospital quality director is responsible for the credentialing of physicians and allied health professionals

False

True or False? Most providers now have real-time access to measurement data that allow them to effectively manage the health of a population.

True

True or False? Process Standardization improves patient safety

True

True or False? The timekeeper keeps the team on track during improvement project meetings.

True

What group is ultimately responsible for the quality of patient care and services in a healthcare organization? A. Board of Trustees B. Medical staff executive committee C. Quality Coordinating Committee D. Senior Administrative Leaders

A. Board of Trustees

What component of the organization's quality management activities is often documented in the QM plan? A. Performance improvement model used in the organization B. Frequency of department staff performance evaluations C. Names of Improvement Project team members D. Procedure for reporting adverse patient events

A. Performance Improvement model used in the organization

"In regard to team development, what is the role of the improvement team leader?" A. Recognize development as a natural team progression B. Move the team through stages as quickly as possible C. Switch team ground rules from stage to stage D. Encourage the team to skip the storming stage

A. Recognize development as a natural team progression

What is the primary reason for analyzing patient incident data? A. To identify unsafe patient care situations B. To find which caregivers are not doing their job well C. To understand the risk of patient care lawsuits D. To create a database of patient incident information

A. To identify unsafe patient care situations

True or False? Every healthcare organization has at least one patient safety coordinator

False

True or False? The likelihood of human errors causing patient harm can be greatly reduced by disciplining staff for making mistakes.

False

True or False? There is no reason to investigate what happened to cause a near miss event because no patient was harmed.

False

Which of the following tasks is commonly done by hospital case managers? A. Arrange for services that patients need after discharge B. Document the condition of patients at time of admission C. Assist nurses with administering patient medications D. Obtain patients consent for elective surgeries

A. Arrange for services that patients need after discharge

For what purpose would a cause and effect diagram be used during a root cause analysis? A. Brainstorm reasons for the event B. Prioritize risk reduction strategies C. Select members of the investigation team D. Pilot test process changes

A. Brainstorm reasons for the event

What tactic is a way to improve the reliability of a healthcare process? A. Create redundancies. B. Add process steps. C. Encourage personal discretion. D. Punish staff who make mistakes.

A. Create redundancies

What is the first step an organization should take when transforming the quality culture? A. Find out the prevailing core values and beliefs B. Establish new behavioral norms C. Measure compliance with quality expectations D. Develop a cultural change action plan

A. Find out the prevailing core values and beliefs

What national performance measurement project contains many measures applicable to population health care? A. Healthcare Effectiveness Data and Information Set (HEDIS) B. Consumer Assessment of Healthcare Providers and Systems (CAHPS) program C. Outcome and Assessment Information Set (OASIS) D. Skilled Nursing Facility Quality Reporting Program (SNF QRP)

A. HEDIS

Which of the following situations is an example of prospective utilization review? A. Health plan evaluates the medical necessity of a member s upcoming surgery. B. Case manager assesses the readiness of a hospital patient s discharge. C. Physician admits a patient with chest pain to the hospital. D. Surgeon s office provides hospital with patient s insurance information.

A. Health Plan evaluates the medical necessity of a members upcoming surgery

What is an publicly available online source of national comparative data on use of healthcare resources? A. Health Care Cost and Utilization Project B. Centers for Disease Control C. Joint Commission Quality Check D. Medicare Physician Compare Initiative

A. Healthcare Cost and Utilization Project

"The study of interactions between people, technology, and policy for the purpose of improving work reliability is called what?" A. Human factors engineering B. Work systems analysis C. Six Sigma D. Quality assurance

A. Human factors engineering

"According to the Health Research & Educational Trust (HRET) of the American Hospital Association, which of the following is a provider initiative that will advance population health?" A. Improve care quality and patient safety. B. Increase hospital and emergency bed capacity. C. Reduce the cost of preventive health services. D. Introduce personal care and wellness technologies.

A. Improve care quality and patient safety

What factor makes an improvement team work most effectively? A. Operates under an agreed-upon set of ground rules B. Works without an agenda and just goes with the flow C. Is given a very short time period to complete a project D. Excludes stakeholders with differing viewpoints

A. Operates under an agreed-upon set of ground rules

What report provides hospitals with provider-specific Medicare data statistics for discharges and services vulnerable to improper payments? A. PEPPER B. ORYX C. ACO D. AHRQ

A. PEPPER

"To be successful as project team members, what characteristic should individuals possess?" A. People committed to achieving project goals B. Experts in the use of improvement tools C. Senior employees who know the ropes D. Strong-willed people able to persuade others

A. People committed to achieving project goals

According to Dr. Avedis Donabedian, what is the most important prerequisite to ensuring a healthcare organization will be high performing? A. There is a systemic quality management framework B. All individuals are truly committed to quality C. Leaders encourage people to achieve performance excellence D. Care providers have clear standards and expectations

B. All individuals are truly committed to quality

Which of the following factors is NOT considered when determining the medical necessity of a healthcare service? A. Scientific evidence supporting use of the service B. Convenience of the patient or the provider C. Cost-effectiveness of the service or the alternatives D. Potential benefits and harms to the patient

B. Convenience of the patient or provider

What is the primary purpose of utilization management? A. Reduce fraudulent billing practices B. Eliminate under- and overuse of health services C. Stop patient dissatisfaction and high costs D. Expand formation of accountable care organizations

B. Eliminate under and overuse of health services

What individual assists the leader in managing discussions during improvement project team meetings? A. Sponsor B. Facilitator C. Recorder D. Process owner

B. Facilitator

What diagram is used to illustrate the start and finish times for an improvement project. A. High-level flowchart B. Gantt chart C. Planning matrix D. Charter

B. Gantt Chart

Where is it documented that hospitals must have a utilization review committee? A. Joint Commission accreditation standards B. Medicare Conditions of Participation C. Quality Improvement Organization contract D. American Hospital Association policies

B. Medicare Conditions of Participation

"According to The Joint Commission, which of the following situations represents a sentinel event?" A. Physician falsifies records to obtain additional reimbursement. B. Patient has a stroke after being given an incorrect medication. C. Family complains about possible elder abuse by a nursing aide. D. An unknown assailant robs a home health nurse at gunpoint

B. Patient has a stroke after being given incorrect medication

What is a common cause of performance improvements being unsustainable? A. Improvement project takes longer than six weeks. B. People lapse into the old way of doing things. C. Impact of process changes is not measured. D. There are too many process owners.

B. People lapse into the old way of doing things

What individual or group creates the written charter for an improvement project? A. Team Members B. Sponsor C. Facilitator D. Team Leader

B. Sponsor

Which of the following improvement actions can help achieve 95% process reliability? A. Gather data on the number of failures. B. Standardize the process steps. C. Train people to complete the process steps. D. Do time-work studies to improve efficiency.

B. Standardize the process steps

What legislation first introduced incentives for providers to adopt population health care strategies? A. Medicare Social Security Amendments of 1965 B. The Health Maintenance Organization Act of 1973 C. Patient Protection and Affordable Care Act of 2010 D. Improving Medicare Post-Acute Care Transformation Act of 2014

B. The Health Maintenance Organization Act of 1973

"According to The Joint Commission, if a mistake occurs that harms a patient, what must be told to the patient or their representative?" A. Cause of the patient care mistake B. Unanticipated patient outcomes C. Name of the facility s lawyer D> How other patients may be affected

B. Unanticipated patient outcomes

At what level of reliability do most US hospitals now function? A. 90 percent B. 80 percent C. 95 percent D. Less than 80 percent

A. 90 Percent

What traits common to an improvement project team in the norming stage? A. "Little discussion, extreme politeness" B. "A lot of feedback, limited agenda items, members focused on success" C. "Meetings that move quickly, end on time, and accomplish a great deal" D. "Dissension, positioning for influence"

B. A lot of feedback, limited agenda items, members focused on success

What is the primary reason for measuring the effectiveness of improvement actions? A. Comply with Medicare requirements B. Confirm actions are successful C. Complete the P-D-S-A improvement cycle D. Celebrate success with staff

B. Confirm actions are successful

What is a component of an organizations quality management infrastructure? A. Technology B. Measures C. Committees D. Reports

C. Committees

What is the first step of a population health care improvement project? A. Analyze current practices B. Design and implement improvements C. Define the improvement goal D. Measure success

C. Define the Improvement Goal

Which of the following activities is a responsibility of the physician advisor for hospital utilization management functions? A. Discharge patients that no longer require hospital care B. Provide advice on patient record documentation C. Evaluate medical necessity of patient care services D. Serve as chairman of the utilization committee

C. Evaluate medical necessity of patient care services

What terms are used to describe what could go wrong during a process step? A. Incident occurrence B. Criticality measure C. Failure mode D. Risk analysis

C. Failure Mode

What is a basic responsibility of the quality department in a healthcare organization? A. Prioritize organizations quality goals B. Train staff in infection control practices C. Help other departments identify potential quality problems D. Confirm that providers have current licenses

C. Help other departments identify potential quality problems

What type of healthcare organization has an organized medical staff? A. Health Plan B. Nursing Home C. Hospital D. Clinic

C. Hospital

What type of form is used by hospital caregivers to document potential or actual patient safety concerns? A. Risk summary B. Environmental assessment C. Incident report D. Check sheet

C. Incident Report

What is a quality related support position in a hospital? A. Governing board member B. Admissions Manager C. Infection Control Coordinator D. Chief Financial Officer

C. Infection Control Coordinator

What is the first step of a root cause analysis? A. Develop risk-reduction strategies B. Report event to the governing board C. Understand what happened D. Identify the contributing factors

C. Understand what happened

How long after an improvement project has ended should measurement data be gathered to determine the project s success? A. Six months after process improvements have been implemented B. As long as required by the project measurement plan C. Until the project sponsor is confident improvements are permanent D. Once the Medicare requirements for QAPI have been met

C. Until the project sponsor is confident improvements are permanent

What group is responsible for allocating resources necessary to support QM activities? A. Quality coordinating committee B. Department managers C. Organized medical staff D. Administrative leaders

D. Administrative leaders

Which of the following activities is NOT a component of utilization management? A. Analyze data on the use of medical services B. Use protocols to manage patient care practices C. Evaluate patient s medical needs after hospital stay D. Assess the competence of care providers

D. Assess the competence of care providers

What job aid can be used to remind physicians and other caregivers of key interventions on each day of a patient's hospitalization? A. Standard orders B. Storyboard C. Flowchart D. Clinical path

D. Clinical Path

What source document is used to identify medically necessary services? A. Insurance benefits booklet B. Medicare Conditions of Participation C. Physician orders D. Clinical practice guidelines

D. Clinical Practice Guidelines

During what type of improvement project does the team brainstorm what could go wrong in each step of a process. A. Root cause analysis B. Rapid cycle improvement C. Lean Six Sigma project D. Failure mode and effects analysis

D. Failure mode and effects analysis

What is the primary purpose of root cause analysis and failure mode and effect analysis? A. Evaluate staff performance B. Meet Medicare requirements C. Reduce wasteful process steps D. Improve patient safety

D. Improve patient safety

Who is the individual responsible for keeping the improvement project focused on the improvement goal? A. Facilitator B. Quality Advisor C. Timekeeper D. Leader

D. Leader

True or False? "For a population health care measure, the entire population, not just those receiving care, is being evaluated."

True

True or False? "For noncatastrophic processes, good outcomes depend on having at least 95 percent process reliability."

True

True or False? "Tax-exempt, nonprofit hospitals are required to provide community benefits to maintain their tax-exempt status."

True

True or False? A flowchart can be used to show the approximate start and finish times for the steps of an improvement project.

True

True or False? An episode-based bundled payment is shared among all caregivers during and after a patient s hospitalization for a specific condition.

True

True or False? Evaluating the appropriateness of physicians clinical decisions when caring for hospital patients is the responsibility of the organized medical staff?

True

True or False? Failure mode and effects analysis is a prospective risk assessment technique.

True

True or False? Hospital discharge planning activities involve anticipating and arranging for a patient s medical needs before leaving the hospital.

True

True or False? In a high performing organization, conflict and disagreement are dealt with openly

True