HC quality and PI
Which of the following are routine quality control (QC) measures and uses in healthcare delivery organizations?
All of the answers
The term "balanced scorecard" was first used in a Harvard Business Review article to describe how managers could better organize employee performance appraisals.
False
Which of the following is not a critical component to gaming and low-fidelity simulation?
Having a group of ten or more participants
Which of the following graduate-level education programs included 36 transitional-year interns and 36 family medicine residents in their comprehensive patient safety program?
The correct answer is: University of Colorado
Which of the IHI High-Impact Leadership behaviors is most directly linked and critical to quality measurement and improvement in healthcare delivery organizations?
Transparency
What paradigm shift does the introduction of V-BID address?
a. The shift from volume to value
Populations can be represented by which of the following?
all
Which of the following describes quality improvement (QI)?
all
Which of the following might be useful dimensions for an organizational performance scorecard in healthcare?
all
A meta-analysis found that education, social support, racial segregation, and poverty accounted for about ________________________________.
b. 33% of all deaths in the United States in a year
Variation in physician practice can account for up to what percentage of a hospital's resource utilization?
c. 80%
NCQA's health plan accreditation is based on which of the following?
c. All of the choices
Which of the following is a significant difference between ambulatory and hospital-based improvement efforts?
c. Ambulatory is focused on population-based management
What is the primary reason the board needs a quality committee?
c. Boards don't have the time during board meetings to do the work needed to measure and monitor quality
A population health safety and quality measure should have all of the following characteristics except what?
c. Easy to collect
In which of the dimensions of the IHI High-Impact Quality Framework does measurement play a key role?
d. "Create Vision and Build Will" and "Deliver Results"
As of 2018, how many states used managed care to deliver Medicaid services?
d. 40
In 1978, what percentage of the population with employer-sponsored insurance was in a traditional "indemnity" health plan?
d. 95%
Which of the following is a good example of a "never event" or nonpayment event?
d. A patient getting injured from a fall in the hospital
Which of the following is not a measurement domain in HEDIS?
d. Affordability of care
Which of the following is a challenge to improving the health of communities?
d. All of the choices
The type of payment model used by health maintenance organizations in which physicians are assigned a set of patients and are paid a set amount each month to care for this group is called which of the following?
d. Capitated payment
Which of the following was not part of Pitney Bowes's value-based purchasing approach to reduce healthcare costs for people with diabetes and heart disease?
d. Charging higher premiums for people with diabetes and cardiovascular disease
Culturally competent healthcare systems have all of the following features except what?
d. Culturally homogeneous clinical staff
Which of the following is not a physical determinant of health?
d. Residential segregation
The insurance that a self-funded employer purchases in order to reduce the risk of a high-cost case or a high-cost year is called which of the following?
d. Stop-loss coverage
What foundation provided crucial funding for the redesign of NCQA circa 1990?
d. The Robert Wood Johnson Foundation
Which of the following best describes the proper relationship between the board and management for ensuring quality?
d. The board sets policy and strategy related to quality and holds management accountable for implementing policy and strategy and meeting quality goals
Managed care plans, especially in Medicare and Medicaid, have taken the lead to __________________.
d. address disparities of care
Compared to other Western countries, the United States disproportionately spends ____________________________________.
d. less on social services and more on healthcare
For healthcare safety and quality to be optimized in a population, _______________________________________.
d. public and private personal healthcare systems must be integrated and coordinated
What does an effective debrief allow students to accomplish?
e. Applying the concepts to other contexts
Which of the following is not measured as part of the Medicare Value-Based Purchasing Program for hospitals?
e. Cleanliness of the hospital facilities
If you are the patient, the right number of medication errors, infections, falls, and harm events is ZERO.
true
In what year were the first public HEDIS measures released?
1993
What does an effective debrief allow students to accomplish?
Applying the concepts to other contexts
In the chapter, the author discusses measurement function and purpose and argues that the same set of measures can be used for board, leadership, and management functions.
False
Quality improvement (QI), as described by the author, is heavily dependent on retrospective chart review and root cause investigations to solve problems
False
Scorecard development should primarily be guided by external reporting requirements and regulation
False
Which of the following are popular games used to teach concepts related to effective teamwork, communication, and leadership?
Teeter-totter and dominoes
Which of the following graduate-level education programs included 36 transitional-year interns and 36 family medicine residents in their comprehensive patient safety program?
University of Colorado
The primary safety risk during a transition of care is which of the following?
a. Adverse drug event
Populations made up of racial and/or ethnic minorities _____________________________________.
a. All of the choices
The push for implementation of electronic health records through the Electronic Health Records Incentive Program was a result of which of the following?
a. American Recovery and Reinvestment Act of 2009
What are "best practices" when it comes to board oversight of quality?
a. Board activities to oversee quality that are applicable to most boards at most types of not-for-profit hospitals and health systems, and are considered to be the industry standard for effective governance
How does the board set the quality agenda for the organization?
a. By weighing issues and concerns and setting priorities, such as top goals for the coming year and key targets to achieve in three or five year
Why is it not sufficient to measure outcomes alone?
a. Care processes must also be measured, so that incidents of "almost harm" can be prevented
Which of the following is not a challenge facing safety and quality measurement in population health?
a. Developing, endorsing, and implementing measures of profitability
Which of the following is best defined as a "failure to establish an accurate and timely explanation of the patient's health problem"?
a. Diagnostic error
Which of the following is not a role for public health agencies?
a. Issuing bonds to help health systems raise funds to support capital-expansion projects
What is benchmarking?
a. Measuring the organization's quality performance by comparing it with similar organizations' performance
Which of the following was not a trend associated with the Healthy People 2020 Leading Health Indicators (LHIs), as of March 2014?
a. More adolescents using illicit drugs
The Healthcare Effectiveness Data Information Set (HEDIS) database is developed and maintained by which of the following?
a. National Committee for Quality Assurance (NCQA)
In 2007, the "Joint Principles" released by medical professional societies encouraged which of the following?
a. Patient-centered care based on the medical home model
What is meant by the term "safe harbor," where does it have a role, and what are its limitations? (Select the best answer.)
a. The "safe harbor" is a term used when discussing HSA-HDHPs. Currently, the IRS determines the coverage limits due to tax implications for these types of plans. Under IRS guidelines, certain preventive care services must be fully covered prior to meeting the deductible. This coverage is referred to as the "safe harbor." However, the IRS guidance states that safe harbor coverage does not include "any service or benefit intended to treat an existing illness, injury, or condition, including drugs or medications."
The medical home concept was first described by which of the following?
a. The American Academy of Pediatrics (1960s)
The dashboard reports for the board and quality committee should differ in what primary way?
a. The board dashboard should have the most important information on a single page, with back-up dashboards for more detail; the committee dashboard is more in-depth.
What is meant by the term "precision medicine"?
a. The integration of molecular science into the clinical care of an individual patient. This idea has spurred efforts to develop targeted preventive strategies and disease-specific therapies
Which of the following is not true about the CMS hospital readmissions value-based purchasing program?
a. The program looks at readmissions within seven days of hospital discharge
Which is true about evidence-based care protocols?
a. They are care process maps outlining what steps need to be taken and when to ensure that the patient receives the necessary care for the optimum outcome.
What are the three considerations of clinical nuance?
a. Who is the consumer using the service, who is the provider of the service, where is the service being delivered
Why do physicians and nurses need to be involved at the board level?
c. To help develop strategic goals around quality and cost improvement efforts
To facilitate measuring population health safety and quality, we should __________________________________________.
a. focus on patient-reported outcome measures (PROMs) addressing patient experience and functionality
The court case Darling v. Charleston Community Memorial Hospital found that _________________________________.
a. hospitals can be held liable for the negligence of staff
Physician credentialing is an important component of the board's role in ensuring quality and patient safety. Credentialing determines ___________________________________________.
a. which doctors are qualified are qualified to join the medical staff, which procedures they are qualified to perform, and which conditions they may treat
Over the past decade, there has been an explosion of quality metrics and measurement across health care driven by _________________.
all
Which of the following is the best explanation of how V-BID plans affect cost-effectiveness?
b. As more individuals who are identified to be at risk receive high-value services, such as screenings and treatments at lower costs, the initial costs of care to the healthcare system may increase. However, over time, better management of chronic conditions, better diagnosing of illnesses, and the ability to keep someone out of the hospital due to improved care will drive down costs in the long term.
Which of the following is the report that lays out a clear vision for what a population health safety and quality roadmap should entail?
b. Crossing the Quality Chasm: A New Health System for the 21st Century
What are the basic tenets of a high-deductible health plan?
b. Increase deductible caps but reduce premium payments
Which of the following is not one of the primary uses of quality measures?
b. Justification that no improvement efforts are necessary
Among the many challenges with quality measurement, what were the three key issues referenced in the chapter?
b. Lack of alignment, inefficient collection, and questions about the accuracy and reliability of measure calculations
What is the one thing that health policy experts believe can most improve patient safety and quality?
b. Making changes in how healthcare is financed and regulated
CMS makes its reported quality data available for a variety of uses. Which of the following is not a common use of CMS quality and patient satisfaction data?
b. Nonprofit tax status.
What are the three population-based outcomes described in the IHI Triple Aim?
b. Patient Experience, Population Health, Per Capita Cost
Which of the following programs is considered the first nationwide "pay-for-reporting" program?
b. Physician Quality Reporting System (PQRS)
Health maintenance organizations succeeded in introducing which of the following concepts to large numbers of primary care physicians?
b. Population health
Which of the following is not an aspect of managing the health of employee populations?
b. Rarely incorporating incentives or penalties to drive desired behaviors and outcomes
Which of the following are popular games used to teach concepts related to effective teamwork, communication, and leadership?
b. Teeter-totter and dominoes
The dashboard reports for the board and quality committee should differ in what primary way?
b. The board dashboard should have the most important information on a single page, with back-up dashboards for more detail; the committee dashboard is more in-depth.
Which of the following is not a recommended focal area for population health safety and quality research?
b. The hospital
Which of the following is not a key educational strategy of the AELPS program?
b. Touring local facilities to point out safety concerns
The IHI High-Impact Leadership Framework includes which of the following?
both b and d what leaders do to make a difference and where leaders need to focus efforts
Which of the following serves as a simple definition of value in healthcare?
c. High-quality healthcare at the lowest cost
Hospitals and health systems need to develop and nurture a strong culture of quality throughout the organization. What is the board's first step in developing this culture?
c. Position the commitment to quality centrally in the organization's mission statement and in its strategic planning
All of the following are examples of CMS initiatives to address safety and quality except what?
c. Quality 2030: A Study of Hospital Preparedness (ASHP)
The US Senate passed the CHRONIC Care Act in 2017. What did this act call for?
c. The expansion of MA V-BID plans to all 50 states
What is meant by the term "clinical nuance"?
c. The idea that services and care that benefit one individual may not affect, or may even harm, another
MacroMarkets, a large national retailer, analyzes its data and finds that it is paying anywhere from $300 to $3,000 for an MRI for its covered employees. The median reimbursement for an MRI is $800, so MacroMarkets decides it will now pay up to $800 for an MRI. If an employee wants to go to a more expensive radiology provider, they can—but they will have to pay the difference between the radiologist's contract-allowable reimbursement for an MRI and $800. In value-based purchasing language, $800 is which of the following?
c. The reference price
Based on examples in both TRICARE and general cost-sharing models, what is found to happen as consumer cost sharing increases?
c. Utilization of both nonessential and essential care decreases.
An employer notices that the adherence rate for hypertension drugs in the employee population with hypertension is 60 percent. To increase adherence, the employer decides to make hypertension drugs available to these employees at zero copay. This strategy is best described as an example of which of the following?
c. Value-based insurance design
The board has a legal obligation to ensure quality of care, which falls under which fiduciary duty or duties?
care and obedience
Which of the following is a collaborative approach that seeks to improve health by incorporating health considerations into decision making across multiple sectors and policy areas?
d. Health in All Policies
How are V-BID plans created to consider clinical nuance?
d. Low to no cost sharing for services considered very beneficial in average-to-high-risk groups and higher (or existent) cost sharing for individuals who are not at risk (or a very low risk) of diagnoses
What were the two main strategies used to improve outcomes for people with diabetes who participated in the Asheville Project?
d. Pharmacist-administered coaching/education and value-based insurance design
Margaret suffers from migraine headaches. When she gets a migraine at work, she needs to close her office door, turn out the lights, and rest for an hour. From an indirect cost perspective, this is an example of which of the following?
d. Presenteeism
Which of the following refers to the new set of pathways for physician reimbursement created by the Medicare Access and CHIP Reauthorization Act (MACRA)?
d. Quality Payment Program (QPP)
According to Steinkuehler and Chmiel (2006), games will not replace teachers and classrooms but they might replace which of the following?
textbooks and laboratories
