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Stack #404189

The NCQA is a private not-for-profit organization that is responsible for improving the quality of healthcare and offers an accreditation program that measures among other things, credentials verification, utilization management and preventive services a National Committee for Quality Assurance
This type of performance measure focuses on a process that leads to a certain outcome, meaning that a scientific basis exists for believing that the process, when executed well, will increase the probability of achieving a desired outcome. process measure
A standard of performance or best practice for a particular process or outcome is called a/an: performance measure
The foundations of care giving, which include buildings, equipment, professional staff and appropriate policies are included in what area of performance measurement? Systems
The interrelated activities in healthcare organizations, which promote effective and safe patient outcomes across services and disciplines within an integrated environment are included in what area of performance measurement? processes
A type of PI team that constructs relatively simple and quick "fixes" to improve work process without going through the complete PI cycle is called: Blitz team
Which of the following statements does not represent a fundamental principle of performance improvement? Teamwork is an optional element in performance improvement.
Which of the following is a short description of the purpose on an organization? Mission Statement
Which of the following is a idealistic portrayal of what the organization would like to be in the future? Vision Statement
In JCAHO facilities, the QA review activities target processes that are high volume, high risk, and problem prone. True or flase True
An undesirable occurrence of such magnitude that it warrants comprehensive evaluation is called a: sentinel Events
A PI team role responsible for championing the effectiveness of PI activities in meeting customers' needs and for the content of a team's work is the: Team leader
The process of comparing the outcomes of HIM abstracting functions at your facility with those of comparable departments of superior performance in other healthcare facilities to help improve accuracy and quality is referred to as: Benchmarking
What process assists a healthcare facility in continuously looking at the ways that problems develop and seeking ways to prevent problems from happening in the future? performance improvement
The process of comparing the outcomes of HIM abstracting functions at your facility with those of comparable departments of superior performance in other health care facilities to help improve accuracy and quality is referred to as Benchmarking
What feature is a trademark of an effective PI program? a continuous cycle of improvement projects over time
Patient mortality, infection and complication rates, adherence to living will requirements, adequate pain control and other documentation that describes end results of care or a measurable change in the patient's health care are examples of Outcome measures
The quality improvement team for the HIM department meets to generate ideas to address physician complains about missing dictation reports. What QI tool would prove useful in discussing various recommendations for solving this problem? brainstorming
An indicator about the placement and number of fire extinguishers would be which type? structure
An indicator about the institutions death rate would be which type? Outcome
CQI is best described by the following statements EXCEPT: Corrective action targets clinicians more so than processes.
What must be considered in light of the health care organization's different customers? Quality
Patients should receive care when? Any time they need it
Which of the following is a technique used to generate a large number of creative ideas from a group? Brainstorming
Which of the following is a data collection tool that records and compiles observations or occurrences? checksheet
Which of the following CQI tools would be most useful in determining how the Medical Staff likes or dislikes the new dictation system you have just installed in your HI Department? survey/questionnaire
Which method would be most successful in helping you track the number of delinquent records coming into your department each month, and then further categorizing the total delinquencies by doctor? check sheet
Bar Chart data analysis
Brainstorming data aggregation
Pareto Diagram data analysis
Pie Chart data analysis
The customer is the receiver of a product or service as a result of an organizational process.True or flase True
Internal customers are individuals from outside the organization who receive products or services from within the organization.true or flase flase
A research instruments that is used to gather data and information from respondents in a uniform manner through the administration of a predefined and structured set of questions and possible responses is called: survey
In this type of interview the sequence of questions is not planned in advance and it is conducted in a friendly, conversational manner. unstructured interview
In this type of interview, a predetermined list of questions is used. structured interview
This type of data is also called categorical data and includes values assigned to name-specific categories. nominal data
This type of data is also called ranked data and expresses the comparative evaluation of various characteristics or entities, and relative assignment of each, to a class according to a set of criteria. Question 15 answers ordinal data
This type of data are numerical values that represent whole numbers. discrete data
This type of data assumes an infinite number of possible values in measurements that have decimal values as possibilities. continuous data
This type of data display tool is used to display discrete categories. bar graphs
This type of data display tool is used to display data proportionally. They are used to identify problems or changes in a system or process. histogram
This type of data display tool is used to show the relationship of each part to the whole. pie charts
This type of chart is used to focus attention on any variation in the process and helps the team to determine whether that variation is normal or a result of special circumstances. control chart
The following "sentinel events" must be available for Joint Commission review EXCEPT petechaie due to adverse drug reaction
Occurrences involving injury or property loss are called: potentially compensable events
Which of the following is NOT one of the basic functions of the UR process? Claims Management
The policy and procedure manual no longer reflects current practices. This situation is a risk management issue because: the manual reflects the normal course of business.
A situation that could have resulted in an adverse patient event but did not, either by chance or through timely intervention. Near Miss
A patient injury or death that could be attributed to acts of negligence by health care practitioners or other involved individuals. Potentially Compensable Event
The process of defining and analyzing risks, and then deciding on the appropriate course of action in order to minimize risks. Risk Management
The most fundamental reasons for an actual or potential adverse event. Root Cause
Refers to steps taken to eliminate hazards of to mitigate their effects by reducing severity and/or likelihood of risk associated with those hazards. An example may be monitoring of re-designed process Risk Control
Any happening not consistent with the routine operation of the facility or routine care of a particular patient that could have or did lead to an undesired result. Incident
An improvement model that involves investigation of a sentinel event or other undesirable occurrence to identifying the underling problems that if corrected, would reduce the likelihood of future similar events. . Root Cause Analysis
Determining what risks or hazards exist or are anticipated, their characteristics, duration period and possible outcomes. Risk Identification
Process of comparing the estimated risk against given risk criteria to determine the significance of the risk. May be used to assist in the decision to accept or to treat a process as a risk. Risk Evaluation
Actions undertaken by individuals and organizations to protect health care recipients from being harmed by the effects of health care services. Patient Safety
In compiling statistics to report the specific cause of death for all open heart surgery cases, the quality coordinator assists in documenting patient care outcomes
Review of a planned admission to determine whether the services are medically necessary and whether the patient qualifies for inpatient benefits. Preadmission Utilization Review
Assessment of a patient's readiness to leave the hospital. Discharge Utilization Review
Periodic review during a current admission to determine whether the patient still needs acute care services. . Continued Stay Review
Review of the patient's need for care and of the care provided at the time services are rendered. Concurrent Utilization Review
Review of the appropriateness of the care setting and resources used to treat a patient. Utilization Management
Review of records some time following the patient's discharge to determine any of several issues, including quality or appropriateness of the care provided. Retrospective Utilization Review
Standards that, if met, allow a hospital to receive reimbursement for care provided to Medicare beneficiaries Conditions of Participation
Severity-of-illness or intensity-of-service standards used to determine whether the planned services are medically necessary and require treatment in an acute care setting. Screening Criteria
Review prior to hospital admission to determine whether the planned services re medically necessary and require treatment in an acute care setting. Preadmission Utilization Review
Review at the time of admission to determine medical necessity and appropriateness of care in an acute care setting Admission Utilization Review
What is the role of a case manager? Coordinate medical care and ensure the necessity of the services provided to the patients
A patient's family asked the attending physician to keep the patient in the hospital for a few days more until they could make arrangements for the patient's home care. Because the patient no longer meets criteria for continued stay, if the physician c an inappropriate use of hospital resources
An infection that is brought to the hospital by the patient is called a community acquired
Collection and analysis of data about patient incidents that occur in a hospital is a job responsibility of the Risk Manager
Which of the following established legal liability for hospitals Darling v. Charleston Community Hosptial
A ____________ is a graphic tool used to standardize care for a specific diagnosis. care plan
Which is NOT a type of utilization review? documentation utilization review
Needlesticks, patient or employee falls, medication errors, or any event not consistent with routine patient care activities would require risk reporting documentation in the form of a(n) incident report
The UR Coordinator reviews inpatient records at regular intervals to justify necessity and appropriateness of care to warrant further hospitalization. Which of the following IR activities is being performed? continued stay review
The best protection against injuries and ensuing financial liability is: risk prevention
What is "root cause analysis"? the intense analysis of a sentinel event
A large database that stores every data element collected within a healthcare organization and is used for PI activities is called: Data repository
As based in case law decisions and the JCAHO standards, who is ultimately responsible to assure quality and appropriateness of patient care in a health care facility? Governing body/board of trustees
Physicians who are members of the Surgery Committee meet to review surgical cases referred for quality issues and deviations from standard care norms. This type of review in which a physician’s record is reviewed by his/her professional colleagues is know peer review
The responsibility for performing quality monitoring and evaluation activities in a departmentalized hospital is delegated to: Question 5 answers director of utilization management
The official term for the process for ensuring medical staff competency. credentialing
This type of healthcare organization review is conducted as the request of the healthcare facility seeking accreditation. Question 9 answers voluntary review
Members of healthcare boards of directors are appointed from the community and frequently do not have any specific knowledge of healthcare operations or organizations.True or flase flase
The act of granting approval to a healthcare organization based on whether the organization has met a set of voluntary standards is called: accreditation
1 out of 1 points Correct When healthcare organizations evaluate their JCAHO core measure data with similar organization, they are using this. Comparative performance data
The document in which the leadership of a healthcare organization identifies the organization's overall mission, vision, and goals to help set the long-term direction of the organization as a business entity is called: strategic plan
You are required to follow the rules in 42 CFR 482. What does CFR stand for? Code of Federal Regulations
This organization accredits managed care organizations, managed behavioral health organizations, and credentials verification for physician organizations. National Committee for Quality Assurance
Governance of a healthcare organization is comprised of the board of directors and the: medical staff leaders
This group has the ultimate responsibility for maintaining the quality and safety of patient care provided by its healthcare organization. Board of directors
This organization has been responsible for accrediting healthcare organizations since the middle 1950s and determines whether the organization is continually monitoring and improving the quality of care they provide. Joint Commission on Accreditation of Healthcare Organizations
The act of granting a healthcare organization or an individual healthcare practitioner permission to provide services of a defined scope in a limited geographical area is called: licensure
The work of performance improvement is accomplished through ______. Teamwork
This type of healthcare organization review is performed to fulfill legal or licensure requirements: compulsory review
Which of the following processes is mandatory for healthcare facilities? licensure
This system allows medical professionals to candidly critique and criticize the work of their colleagues without fear of reprisal. peer review
This private, not-for-profit organization is committed to developing and maintaining practical, customer-focused standards to help organizations measure and improve the quality, value, and outcomes of behavioral health and medical rehabilitation progra Commission on Accreditation of Rehabilitation Facilities
Every organization that provides services to Medicare and Medicaid beneficiaries must demonstrate its compliance with this set of standards: Conditions of Participation
A large database that stores every data element collected within a healthcare organization and is used for PI activities is called: Data repository
The act of granting approval for a healthcare organization to provide services to a specific group of beneficiaries is called: certification
This person is responsible for implementing board directives and for action as board representative in managing the operations of the organization. Chief Executive Officer
The organization that coordinates the collection of performance data for managed care plans is the ___________. NCQA
This technology allows organizations to store reports, presentations, profiles, and graphics interpreted and developed from stores of data for reuse in subsequent organizations activities. Information warehouse
Which is following is not part of the Total Management assessment prospective PLANNING
Created by: RHIT2010