Health Systems
What year were the Medicare and Medicaid programs created?
1965
What proportion of serious adverse events indicating a patient safety or quality of care issue is a result of poor communication among team members?
2/3
Which state health care reform law most influenced the approach taken by the Affordable Care Act?
2006 Act Providing Access to Affordable, Quality, Accountable Health Care (Massachusetts)
What is a co-pay?
A flat fee for a healthcare encounter paid by the patient and applied at the location where care is received
Which of the following are limitations of U.S. health care? (select ALL that apply)
A focus on sick care over prevention and wellness Inequity in health and health outcomes
What is a surgical error?
A surgery that was preformed on the wrong site or the wrong patient, involves a retained object within the body, or where the surgical team failed to take precautions to prevent infection.
Which is the best description of the entities that are involved in the public health system?
All public, private and voluntary entities that contribute to the delivery of essential public health services within a jurisdiction
What is an accountable care organization?
An entity charged with management of the entire continuum of care, overall costs, and quality of care for a defined population.
What is a near miss?
An unplanned event or close call that does not reach the patient or cause an injury or damage to the patient
What should health professionals do when faced with a patient impacted by a medical error?
Approach the situation with transparency and provide honest communication
What are the ways a clinician can determine if a patient is challenged with or impacted by various social determinants of health? (select ALL that apply)
Asking patients about their ability to buy food Putting a kiosk in the waiting room that includes a questionnaire on the social determinants of health Asking patients about how they get to medical appointments Asking all patients to complete a pre-appointment written survey focused on multiple social determinants
A 55-year-old man is discharged home after hip replacement. The patient does not fill the prescription for the anticoagulation medication because it is too expensive. He returns to the hospital one week postoperatively with a pulmonary embolus. Which of the following habits of a systems thinking health professional could have potentially prevented this complication?
Changes perspectives to seek understanding.
What are the most common sources of error?
Defective systems
Which of the following data sources can inform the development of quality measures?
Direct observation Administrative data Surveillance data Data abstracted from patient records
Which of the following issues are impacted by the unemployment rate? (select ALL that apply)
Domestic violence Substance abuse Depression
What is a "Just Culture"
Each member of the health care team advocates for an environment where safety concerns can be addressed in a non-punitive manner with willingness to address underlying cause
Within a fee-for-service payment model, physicians are paid based on?
Each particular service rendered
What is quality improvement?
Effort to make changes that will lead to better patient outcomes, system performance, patient experience, and professional development.
What tools can a health system use to address population health? (select ALL that apply)
Electronic health record (EHR) Patient portal List of community-based resources
Which of the following is an intervention that can address a common health care quality issue?
Equipment redesign and forcing functions
Which of these is curricular content included in the health systems science domain of health care structure and processes
Fragmentation and inefficiencies encountered by patients in the healthcare continuum
Why is it important for a physician to be a systems thinker? (select ALL that apply)
Health systems are complex Health systems are adaptive
What is the first strategy physicians can use to promote high-value care?
Identify and classify health care gaps that lead to waste, errors and missed opportunities
What can knowledge about health systems science do to improve patient care? (Select ALL that apply)
Identify blind spots that interfere with patient care Identify and address social determinants of health that may be impacting the health status of a patient
Which of the following is included in quality improvement in a team setting? (Select ALL that apply)
Identify errors Implement basic safety design principles Continually measure quality of care Test interventions that change process
What are the components of the Triple Aim? (Select ALL that apply)
Improving the health of a defined population Enhancing the patient care experience Reducing per capita costs of care
Why is the health system a complex adaptive system? (select ALL that apply)
It is a set of interconnected parts. It is composed of individuals who learn and change as a result of their experiences
Why is an understanding of health systems science important for physicians and other healthcare professionals?
It will help achieve the Triple Aim.
What is the primary objective of a high quality health care system?
Keep the population healthy.
What are the components of a professional identity?
Knowledge, skills, behavior
What is one factor that can lead to poor team performance?
Lack of understanding roles
Which of the following is a new health care worker role that supports population health activities? (select ALL that apply)
Nurse care manager Community health worker Patient navigator
Which of the following has been shown to be associated with food insecurity?
Obesity and higher hemoglobin A1c numbers
What kind of resources should a medical practice have on hand in order to address social determinants of health? (select ALL that apply)
On-site food boxes Lists of available legal assistance resources
Fill in the blanks: In the value equation, quality is defined as __________,__________ and __________.
Outcomes, safety, service
What are possible leadership opportunities for medical students?
Participates in local public health organizations Encourage a systems based approach to problem solving Work with you team to develop quality improvement initiatives Become involved in local, state and national medical societies
PDSA stads for?
Plan, Do, Study, Act
Which action may take it more likely a quality improvement initiative is sustained?
Pre-work to assess the system and the capacity to implement and support changes
Which of the following descriptions best defines value in health care?
Quality (outcomes + safety + service) / total cost
Health policy is generated or changed when which three forces align?
Scientific evidence base, social strategy and political will
A shared goal is considered crucial to an effective team. What does a shared goal mean? (Select ALL that apply)
Shared perception of a situation/task Team-wide understanding of the goal
Which of these are characteristics of high-performing teams? (Select ALL that apply)
Shared understanding of the team goal Clear definitions as to member's roles Team cohesion and low levels of conflict
A physician recently joined a new practice at the university hospital. He notices that 80% of his patients are late for their appointments. He begins charging them a late fee because he feels they are disrespecting his time. He is subsequently told that the parking structure is undergoing renovation and patients have been having a hard time finding a place to park. Which of the following habits of a systems thinking health professional could have prevented the physician from jumping to conclusions and penalizing patients for issues out of their control?
Surfaces and tests assumptions
What is systems thinking as it relates to health care delivery?
Taking a holistic approach to health care which allows health professionals to see the whole and recognize cause and effect.
Which of the following is true of the current health care payment system?
The current system promotes volume over value.
Which of the following are aspects of population health? (select ALL that apply)
The health outcomes of a group of individuals, including the distribution of health outcomes within the group Recognizing that an individual's health status is linked to his or her behavior, home, work, school and other environments Recognizing that health status is not just determined by a patient's interactions with the health care system
Why has the proportion of the U.S. population with government-sponsored coverage continued to grow? (Select ALL that apply)
The number of people over the age of 65 years has increased Income eligibility requirements for Medicaid have become more generous, because of reforms such as the Affordable Care Act
In order to improve health care delivery, practitioners must be aware of high-value care practices. Which of the following statements best describes the current state of trainees' knowledge and practice of high value care?
The practice environment where the trainee trained impacts the high value care practice of that trainee.
What are examples of curriculum within population, public and social determinants of health? (Select ALL that apply
The process of building a community asset map to identify local resources that can help address a leading health indicator Definition of patient risk factors within the context of social determinants of health in uninsured populations Practicing cultural skills to work with individuals from diverse cultural backgrounds
Why is leadership training important for physicians?
To handle the unique challenges emerging as health care delivery evolves
What are some of the domains of health systems science? (Select ALL that apply)
Value in health care Health care policy and economics Clinical informatics and health technology Population, public and social determinants of health
Which of the following are part of the "executive toward a vision" domain of leadership?
Values-based visioning and strategy, create a positive culture, create sustainable solutions, change management
Which of the following are social determinants of health? (select ALL that apply)
Where a person lives Ability to afford healthy foods Education level
What is a leadership competency for physicians?
Working well with a team
The Institute of Medicine's six dimensions of healthcare quality states that care should be:
safe, timely, effective, efficient, equitable, and patient-centered (STEEEP).
