HIM 120 Test II

Created by j2b36 

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Which of the following is the goal of clinical practice guidelines?

to standardize clinical decision making

Which of the following is the largest healthcare standards setting body in the world?

joint commission

Which of the following is not responsibility of a healthcare organization's quality mangement dept.?

using medical peer review to identify patterns of care

Problems in patient care and other areas of the healthcare organizations are usually inherent in a

system

which of the following statements best defines utilization management?

it is a set of processes used to determine the appropriateness of medical services provided during a specific episode of care

which of the following is not a type of utilization review?

documentation of utilization review

what is the role of the case manager?

to coordinate medical care and ensure the necessity of the services provided to beneficiaries

Which role is not representative of the omsbudsman in patient advocacy?

judge

A hospital's C section rate is an example of a

clincial performance measure

the process that involves ongoing survellience and prevention of infections so as to ensure the quality and safety of healthcare for patients and employees is known as

infection control

the traditional approach to assuring quality was study a process only when there was failure to

meet established standards

Donabedian proposed three types of quality indicators: structure indicators, process indicators, and

outcome indicators

Many organizations and quality experts define quality as meeting or exceeding

customer expectations

Which of the following is a technique used to generate a large number of creative ideas?

brainstorming

Which of the following is a data collection tool that records and compiles observations or occurences?

checksheet

which of the following is used to plot the points for two variables that may be related to each other in some way?

scatter diagram

The leader of the coding performance improvement team wants all of her team members to clearly understand the coding process. Which of the following would be the best tool for accomplishing this objective?

flowchart

the medical transcription improvement team wants to identify the cause of poor transcription quality . Which tool would be the best aid in identifying the root cause of the problem?

fishbone diagram

according to the pareto principle

20% of the sources of a problem are responsible for 80% of its actual effects

which statement does not represent a fundamental principle of performance improvement?

1. teamwork is an optional element in performance improvement
2. systems are static and do not demonstrate variation

The medicaid conditions of participation require all healthcare facilities to institute utilization management programs. Critique the statement

acute care hospitals are required to have a UM program

Critique this statement: the purpose of quality improvement organizations is to review the reimbursement claims for Meidcare and Medicaid inpatients to ensure that the care was medically necessary, appropriate, and high quality.

this is a true statement

Every healthcare organization's rsk management plan should nclude the following components

objectives, key elements, responsiblities, methods and areas of focus for the current year

which of the following is not one of the basic functions of the utilization review process?

claims management

Which of the following federal agences is empowered to monitor and regulate the safety of health caae facilites?

CMS,OSHA,CDC Answer is ALL OF THE ABOVE

which of the following are detailed step by step guides used by healthcare practioners to make clinical decisions related directly to patient care?

clinical practice guidelines

Which of the followng are predefined statements of the criteria against which the perfomance of a healthcare organizaton will be assessed during a voluntary review process?

accreditation standards

Which of the following documents the results of care for individula patients as well as for specifc types of patients grouped by diagnostc category?

outcome measure

Which organization initiated ORYX initiative program for developing outcome measures?

Joint Commission

under the ORYX system, all hospitals and skilled nursing facilities must report outcome measures on at least what percentage of their patients?

20%

which organizaton sponsors HEDIS reporting system?

NCQA

Which of the following organizations provides the most complete vew of managed care plan quality?

NCQA

What is the goal of the Health Care Quality Improvement Program?

improving the health of Medicare beneficiaries

What term is used for the process of determining whether the medical care provided to a specific patient is medically necessary?

utlilization review

refers to the computerized systems into whch phys. Or hospital staff directly enter medicaton orders and therefore beneft from immediate aleters and pharmaceutical information in order to reduce the frequency of medication errors.

CPOE

are JC's standards for improving patient safety

NPSGs

are contracted to the federal govt. to use medical peer review, data analysis, and other tools to identify patterns of care and outcomes that need improvement and then to work cooperatively with facilities and individual phys. To improve care

QIOs

refers to the intiative and programs that reward organizations and providers for quality outcomes

Pay for Performance

is a methodology for assessing compliance with JC standards during the survey process

Tracer Methodology

execution of pattern

performance

involving personnel in the ongoing improvement of services provided

performance improvement

the process of preventing the spread of comunicable diseases in compliance with applicable legal requrements

infection control

a group of processes used to measure how effeciently healthcare organizations use their resources

utilization management

the process of overseeing medical, legal, and administrative operations within a healthfcare organization

risk management

detailed clinical procedures that consist of steps expilicitly recommended by an authoriative body

clinical protocals

detailed descriptions of the compulsory requirements in federally sponsored health programs

government regulations

detailed descriptons of the criteria health care organizations must fulfil in order to provide services in a specific geopolitical locale

licensure requirements

predefined statements describing the criteria against which an organization's performance will be assessed as part of a voluntary accreditation process

accreditation standards

systemically developed statements used to inform clinical decision making

clincial practice guidelines

care planning tolls that emphasize the coordinaton of multidisciplinary clinical serviices

critical paths

severity of illness or intensity of service standards used to determine the most appropriate care setting

screening criteria

assessment of 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 utilization review

review of a planned admission to determine whether the services are medically necessary and whether the patient qualifies for inpatient benefits

continued stay utilization review

process of determing whther the medical care provdided to a pecific patient is necessary

utilization management

review of records some time following the patient's discharge to determine any of several issues, including the quality or appropriateness of the care provided

retrospective utilization review

review conducted at the time of hospital's admission to determine the medical necessity and appropriateness of care in an acute care setting

admission utilization review

standards that, if met, allow a hospital to receive reimbursement for care provided to Meicare beneficiaries

conditions of Participation

review conducted prior to hospital admission to determine whether the planned services are medically necssary and require treatment in an acute care setting

preadmission utilization review

review of patient's need for care and the quality of the care provided at the time services are renedered

concurrent utilization review

generating a large number of creative ideas from a group

brainstorming

organizing similar ideas into logical groupings

affinity grouping

developing agreement about the relevance of an issue or an idea

nominal grouping technique

rating the relative importance of issues of ideas by marking them with a distribution of points

multivoting technique

developing a common understanding of a process

flowchart

performing a cause and effect analysis

root cause analysis

displaying ranked items

pareto chart

displaying data on the drivers of, and barriers to, a proposed change

force-field analysis

collecting and recording observations or occcurences

checksheet

plotting the points for two variables to determine whether they are related to each other

scatter diagram

displaying frequencies of responses

histogram

diplaying data points over a period of time

run chart

displaying data points in comparison to upper and lower control limits

statistical process control chart

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