Chapter 6; Quality in Healthcare
1.What is a system to measure the performance of a process, item, or service against a defined standard? A.Quality Assurance B.Quality Control C.Continuous Quality Improvement D.None of the above
1.Answer: B Rationale: Quality Control (QC) is a system to measure the performance of a process, item, or service against a defined standard. QC includes calibrations and analyses of check samples (performance evaluation samples, duplicates, spikes, blanks, etc.) to assess the bias and precision associated with sample results.
10.Which of the following processes will make quality improvement meaningful and reduce medical errors? A.Using a computerized provider order entry (CPOE) of medications (e-prescribing) B.Medication reconciliation C.Using computerization to track, report and measure quality D.All of the above.
10.Answer: D Rationale: Errors in medicine cannot be eliminated, but certain areas are amenable to improvement through quality management—for example, prescription medication errors. Converting this process to computerized provider order entry (CPOE) of medications (e-prescribing) may reduce medication errors. Medication reconciliation, the process whereby an accurate and updated list of the patient's medications is available to care providers in multiple settings, can only be achieved through tightly integrated processes implementing quality improvement. Current trends in HIT include greater systems integration, improved usability of interfaces, greater focus on workflow, and a process of ongoing provider training. By making quality improvement meaningful and increasingly effective, the use of computerization will make it easier to track, report, and measure quality. These quality data indicators should then be used to make improvements that will evolve quality so that it meets the highest standards within healthcare.
2.As the practice manager, you notice that charges are not being coded as quickly as you believe they should. When you speak to the coders, they complain that there are too many doctors and not enough coders to code all the charges in the timeframe you have requested. What resource could you use to find benchmark information to indicate how many coders you should employ in your practice? A.MGMA Annual Survey B.Quality Improvement Organizations C.CMS website D.Ask the practice next door how many coders they have
2.Answer: A Rationale: Benchmarking is measuring and comparing data to internal or external results. Internal benchmarking compares measurements acquired from internal processes, over time. External benchmarks can be obtained through organizations (such as MGMA) that perform yearly surveys of medical groups around the country.
3.Under MIPS, which of the following is NOT considered an improvement activity? A.Expanding practice access B.Participation in an APM C.Patient Safety and Practice Assessment D.Practice profitability
3.Answer: D Rationale: Improvement activities under MIPS are broken down into nine subcategories: 1. Expanded Practice Access 2. Population Management 3. Care Coordination 4. Beneficiary Engagement 5. Patient Safety and Practice Assessment 6. Participation in an APM 7. Achieving Health Equity 8. Integrating Behavioral and Mental Health 9. Emergency Preparedness and Response
4.Several patients have presented to the office over the last three weeks complaining they have not received their lab work or received incorrect results. To improve this process, you use the Plan, Do, Check, Act method. Which options below are included in this method? I.Gather a team of the key players together to outline the plan and list steps to achieve the goal. II.Perform small-scale testing to determine if the plan will work. III.Ask other practices if they have this same problem. IV.Check to see if improvements have been made. V.Implement a plan outlined by key players of a team. A.I, II, III, and IV B.I, II, III, and V C.I, II, IV, and V D.II, III, IV, and V
4.Answer: C Rationale: Plan, Do, Check, Act (PDCA) is a quality cycle and QI method that imposes a formal approach to QI and can result in significant benefits. Plan: To plan for a change, you need a benchmark or goal for improvement. For example, Practice A has a 40 percent denial rate on its ancillary services. A review of denials determined 86 percent are for services deemed not medically necessary, with 69 percent for lab services. Key players to reduce denials might include the lab manager, a nurse, and a member from the coding and billing department. This team should outline its plan with the goal, benchmark data, and a list of steps to achieve the goal. A plan might include tools to help the physician/nurse team identify when a service may be considered not medically necessary, so that an ABN can be obtained. Do: Small-scale testing will help the team to determine whether the plan will work. For the denials at Practice A, the nurse on the team uses the Medicare National Coverage Database to determine if the service is considered a medically necessary service for the diagnosis. If not, the nurse will obtain an ABN from the patient. The lab will double-check the diagnosis and medical necessity of the service. The billing department will check the ABN to verify the correct diagnosis is attached to the procedure performed, and that the necessary modifiers are applied when an ABN is obtained. Check: Review the original benchmark data to determine if improvements are made. The team discusses the successes and the potential issues with the current plan. In our example, the medical necessity denials are reduced to 10 percent for the provider testing the plan; however, the nurse points out the amount of time it takes to check each service to determine the medical necessity. The team works to ease the process and reduce the time involved and modifies the plan. Act: When the Plan, Do, Check cycle is successful, the plan becomes part of the regular business processes.
5.All the following are steps to initiate effective benchmarking EXCEPT: A.Identify what you want to measure and improve and how you will obtain measurements B.Decide what improvements can be made to improve your processes C.Only complete process once and then move on D.Repeat-determine if your goals are accomplished and identify continual opportunities for improvement
5.Answer: C Rationale: Simple steps to initiate an effective benchmarking effort include: -Identify what you want to measure and improve and how you will obtain measurements -Measure the performance of the process you have selected -Identify what benchmark you are going to compare your measurements to -Compare your measurements to that of your identified benchmark -Identify the difference between your measurements and that of your benchmark -Decipher the reason for these differences -Decide what improvements can be made to improve your processes -Implement new processes or policies to accomplish improved measurements -Repeat and determine if your goals are accomplished and identify continual opportunities for improvement
6.Which of the following are examples of quality control (QC) processes? I.Comparing processes to other providers in the area II.Calibrating the blood pressure machines III.Testing the fire extinguishers in the clinic IV.Verifying accurate temperatures for the refrigerators containing vaccines V.Turning up the temperature of the refrigerators at night to save cost A.I, II, and V B.I, III, and V C.II, III, and V D.II, III, and IV
6.Answer: D Rationale: Quality Control (QC) is a system to measure the performance of a process, item, or service against a defined standard. QC includes calibrations and analyses of check samples (performance evaluation samples, duplicates, spikes, blanks, etc.) to assess the bias and precision associated with sample results. Examples within a clinic that require quality controls include: -Equipment calibration (eg, lab machines, diagnostic imaging, ECG units, etc.) -Reviewing logs of who is accessing different records within an EMR -Regularly testing fire extinguishers within the clinic -Verifying accurate temperatures for refrigerators holding vaccines
7.What is providing care that is responsive to individual patient preferences, needs, and values and assuring that patient values guide all clinical decisions? A.Equitable care B.Patient-centered care C.Timely care D.Preventive care
7.Answer: B Rationale: Patient-centered - providing care that is responsive to individual patient preferences, needs, and values, and assuring that patient values guide all clinical decisions. -Safe: Avoiding injuries to patients from the care that is intended to help them. -Effective: Providing services based on scientific knowledge. -Timely: Reducing wait times and delays for those who receive care and those who give care. -Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy. -Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, or socio-economic status.
8.Which option is FALSE regarding Quality Assurance (QA)? A.It is an integrated system of management involving planning, training, quality control, assessment, data review, reporting and quality improvement to ensure a process, item or service is of expected type and quality. B.Focuses on inspection C.Sets policy and controls to ensure the usability of the product. D.Focuses on prevention of issues.
8.Answer: D Rationale: Quality Assurance (QA) is an integrated system of management involving planning, training, quality control, assessment, data review, reporting, and quality improvement to ensure a process, item, or service is of the expected type and quality. QA sets policy and controls to ensure the usability of the product (eg, data). Quality Assurance is Not Quality Improvement
9.What is a strategy of continuous refinement to improve quality? A.Continuous Quality Improvement B.Quality Outcome Measurements C.Quality Assurance D.Creation of policies and procedures
9.Answer: A Rationale: Continuous Quality Improvement (CQI) is a strategy of continuous refinement to improve quality. All activity and processes can be defined as individual processes. By making each process or workflow function better, the overall process becomes more efficient. Greater efficiency translates into less waste, consistent treatment, and potentially greater profits. Quality improvement is not a one-time fix, but an ongoing effort.