RHIT D5 Quality

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audit Health records for content, apply standards, conduct clinical pertinence reviews. etc

What would be best scanning process for HIM department in hospital's health record be able to remotely perform coding and cancer registry functions.

[Scanning all documents at the time of patient discharge]. The data can be interfaced in the current EHR with the document scanning system.

In conducting a qualitative analysis to ensure that documentation in the health record supports the diagnosis of the patient, what documentation would a coder look for to substantiate the diagnosis of aspiration pneumonia?

[Patient has history of inhaled food, liquid, or oil]. Aspiration pneumonia is an infection of the lungs due to the aspiration of sucking of food particles, fluid, or vomit, into the lungs.

Which is an organization's planned response to protect its information in the case of a natural disaster?

[Business continuity plan BCP]. to handle an unexpected computer shutdown caused by an intentional or unintentional event or during a natural disaster.

What is the responsibility of a healthcare organization 's quality management department?

Helping departments to identify potential clinical quality problems, Participating in regular departmental meetings across the organization, Determining the method for studying potential problems such as survey, chart review, or interview with staff. training organization members on quality and performance improvement methodology, tools, and techniques.

Who has the ultimate responsibility for ensuring quality in a healthcare facility?

[The board of directors], they ensure the quality of the medical care provided in the organization and organization's fiscal(financial) stability.

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

[Infection control] is a system that prevent a communicable diseases on protecting healthcare workers and patients against exposure to disease.

What is the function of risk management plan in healthcare organization?

Risk identification and analysis, loss prevention and reduction, and claims management.

What is the best to provide process measure metrics in a precise format?

[Dashboard (Scorecards)] is a tools that present metrics from a variety of quality aspects in one concise report. for example infection rates, financial quality, volume, and patient satisfaction.

Total quality management and continuous quality improvement are well-known:____

Performance improvement models. The quality concept is the measurement. Quality masters is the key to improvement lay in the measurement of the important characteristics of healthcare and professional practice. "Measure quality"

Donabedian proposed three types of quality indicators: Structure indicators, process indicators, and____

[outcome indicators]. Structure indicators measure attributes of the setting such as number and qualifications of the staff, adequacy of equipment and facilities, and adequacy of organizational policies and procedures; process indicators measure the actions by which services are provided the things people or devices do, from conducting appropriate tests, to making a diagnosis, to actually carrying out a treatment; and outcome indicators measure the actual results of care for patients and populations including patient and family satisfaction.

Many organizations and quality experts define quality as meeting or exceeding___

Customer expectations

Managing the adoption and implementation of new processes is called____

Change management

W. Edwards Deming believed that quality must be built into the____

Product

A key feature of performance improvement is_____

A continuous cycle of improvement including measurement, analysis, monitoring, planning, designing, and evaluating.

Brainstorming, affinity grouping, and nominal group techniques are tools and techniques used during performance improvement initiatives to facilitate_____among employees.

[Communication] Brainstorming is a technique used to generate a large number of creative ideas from a group. This technique It helps people to begin thinking in new ways and gets them involved in the process and it an excellent method for facilitating open communication.

What is term refers to the process of planning for change?

[Change Management] is introducing change, getting it adopted, and diffusing it throughout the organization.

What data collection tool that records current processes?

[Flow chart] help all the team members understand the process in the same way. It allows the team understand every step in the process as well as the sequence of steps. It's provide a visual picture of each decision point and each event that must be completed.

What is the Force-Field Analysis?

It's another tool used to visually display data generated through brainstorming. The team leader will draws a large T shape on a board then write word drivers on one side and Barriers on the other. The team members then brainstorm the reasons or factors that would encourage a change for improvement and those that might create barriers.

How pareto chart is use?

A Pareto chart is looks like a bar chart except that the highest-ranking item is listed first, followed by second highest, down to the lowest-ranked item. The purpose is to display how the team ranked the problems and to allow the team to focus on those problems that have the biggest potential for improving the process. So it prioritization of issues, problems, or solutions.

What is Scatter diagrams and how it used?

Scatter diagrams are used to plot the points for two continuous variables that may be related to each other in some way. For example, one might want to look at whether age and blood pressure are related. The conclusions about the variables'relationship, either positive or negative that indicates of the points that are moving together in on direction or another.

According to the Pareto Principle____

20 percent of a problem's sources are responsible for 80 percent of its actual effects. By concentrating on the "vital few" sources, the team can eliminate a large number of undesirable results.

Change management is the process of planning for change. It concentrated on____.

[Addressing employee resistance to changes in processes, procedures, and policies]. Change management is a process of introducing change, getting it adopted, and diffusing it throughout the organization. This includes clearing the air and answering questions to reduce fear of, and resistance to, change.

Performance improvement is base on several fundamental principles, including_____

The structure of a system determines its performance, all systems demonstrate variation, all systems demonstrate variation, improvements rely on the collection and analysis of data that increase knowledge, PI requires the commitment and support of top administration,PI works best when leaders and employees know and share the organization's mission, vision and values; PI efforts take time and require a big investment in people; excellent teamwork is essential; communication must be open, honest, and multi-directional, and success must be celebrated to encourage more success.

What is the first step to establish benchmarks for any healthcare facility or department?

First step is to determine the performance measure to be studied and what is to be accomplished. Once a benchmark for a performance measure is determined, analyzing data collection results becomes more meaningful.

A record that fails quantitative analysis is missing the quality criterion of_____.

[completeness] Quantitative analysis is used by HIM technicians as a method to detect whether elements of the patient's health record are missing, or not complete.

A report that lists the ICD-9-CM codes associated with each physician in a healthcare facility can be used to assess the quality of the physician's services before he or she is_____.

Recommended for staff reappointment.

What does Clinical privileges means?

Clinical privileges are the defined set of services a physician is permitted to perform in that facility.

What does credentialing means?

The credentialing is the process that includes both the initial appointment and reappointment of individuals to the medical staff and determination of the extent of their privileges. in another word it is the process of reviewing and validating the qualifications (degrees, licenses, and other credentials) of physicians and other licensed independent practitioners, for granting medical staff membership to provide patient care services

What is the medical staff?

Medical staff is the aggregate(formed by) of physicians who have been given permission to provide a healthcare facility's clinical services.

When all required data elements are included in the health record, the quality characteristic for_____ is met.

Data comprehensiveness/completeness

The sixth scope of work for quality improvement organization QIOs introduced____

It's shifted from the quality focus of the early 1990s to a [payment error prevention role and introduced the Payment Error Prevention Program.

After an outpatient review, individual audit results by coder should become part of the_____

Individual employee's performance evaluation

The primary goal of the Hospital Standardization Program established in 1918 by the American College of Surgeons was to____

To rise the standards of surgery by [establish minimum quality standard for hospital].

A quantitative tool that provides an indication of an organization's performance in relation to a specified process or outcome is a/an______

[Performance measure ] it measures process and out come by comparing the performance in comparison to a specific process or outcome.

What is the step in quality improvement decision-making?

Definition of the problem, Development of alternative solutions, implementation and follow-up. This will take time not done quickly

The principal process by which organizations optimize the continuum of care for their patients is____

[Case management], review the condition of patients to identify each patient's care needs and to integrate patient data with the patient's course of treatment.

When the patient's physician contacts a healthcare organization to schedule an episode of care service, the healthcare organization begins which step in the case management process?

[Preadmission care planning] is initiated/first when the patient's physician contacts. The case manager reviews the patient's projected needs with the physician. Admission criteria are established based on a suggested diagnosis.

The case manager confirms that the patient meets criteria for the care setting and that the services can be provided at the facility.

Care planning at the time of admission

The interrelated(interrelationship/bring in together) 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], are the interrelated activities in healthcare organization

The performance measure that enables healthcare organizations to monitor a process to determine whether it is meeting process requirements is called____

[Indicator or criterion] The indicator or criteria may be established and implemented internally, externally, or generically

This status is conferred by a national professional organization that is dedicated to a specific area of healthcare practice.

[Credential] are recognition by healthcare organizations of previous professional practice responsibilities and experience commonly accorded to licensed independent practitioners.

Which is a services is most likely to be considered medically necessary?

[Standard of care for health condition].

Who is responsible for ensuring the quality of health record documentation?

[Provider]

What is the typical reviewed for medical necessity and utilization?

Rehabilitative therapies, inpatient admissions, mental health and chemical dependency care

What are the important function of performing the utilization management program?

Utilization review, case management, and discharge planning.

What is the utilization review UR?

Is the process of determining whether the medical care provided to a specific patient is necessary.

What is basis of utilization review?

Pre-established objective screening criteria which is performed according to time frames specified in the organization's UM plan. The hospital may develop its own criteria or use criteria established by other sources for utilization review.

UR can be performed _____

Prospectively(before care is provided), concurrently(while care is being provided), or retrospectively(after the episode of care is complete.

How pre-admission utilization review or prospective UR is conduct?

It's conducted to determine whether the planned service (intensity of service) or the patient's condition (severity of illness) warrants care in an inpatient setting.

What is admission utilization review?

Is conducted at the time of admission for example through hospital emergency department this is the same as pre-admission UR.

What is Continued-stay UR.

Is conducted to determine whether the patient continues to require inpatient care. the purpose is to ensure that patient's LOS is not being unnecessarily prolonged and the hospital's resources are being used efficiently.

What is retrospective utilization review?

Is conducted after the patient has been discharged by examines the medical necessity of the services provided to the patient. It may be conducted by a peer review organization of a hospital committee to evaluate quality issues, cost issues, and LOS factors, and LOS factors, as well as the appropriateness of the patient's admission and the utilization of hospital resources.

What is the condition on Hospital-Acquired Condition provision for FY 2009

Catheter-associated urinary UTI, pressure ulcers, serious preventable event such as object left in surgery, air embolism, blood incompatibility, vascular catheter-associated infection, mediastinitis after CABG, falls and fractures, dislocation, intracranial injury, crushing injuries, and burns.

Fundamental of healthcare organization work plan includes_____

Strategic and operational planning. Strategic planning is a long term approach to the future like over a t least a five-year period. Operational planning is short-term activities apply chiefly to the next calendar year.

What is the primarily concerned of strategic planning? This is a organization's board of director primary responsibility.

Is how the organization will respond to changes in its external environment in the foreseeable future. such as organization's external business climate, its competitive status, and/or the broader social and political climate in which it operates.

Strategic planning involves_____ steps.

Conducting an environmental assessment (organization's internal and external environment from previous year), Developing and/or revising the mission and vision statements in response to the environmental assessment, Developing and/or revising the values statements, Developing and/or revising the strategic plan for the upcoming year, Revising the strategic plan for the succeeding years in light of the changes made to the plan for the upcoming year, developing specific action steps for the upcoming year, Discussing the proposed strategic plan with the board of directors and making changes as a result, Officially documenting the board's approval of the plan, Communicating the strategic plan to the administrators and managers, Developing operation plans for the upcoming year on the basis of the action steps and future direction documented in the final strategic plan.

What is the information that National practitioner data bank NPDB collected about physician.

Credentialing information, disciplinary actions, and professional society memberships.

The Joint Commission's quality improvement activities for health record documentation including core performance measures for hospitals:

core performance list: Acute myocardial infarction,heart failure (HF), Hypertension, pregnancy and related conditions/Perinatal Care, Venous Thromboembolism, Emergency Department Surgical Care, Improvement Project, Substance Use, Tobacco Treatment, Pneumonia Measures, Immunization, Children's Asthma Care, Hospital-Based Inpatient Psychiatric Services,
Stroke, Hospital Outpatient Department

This data set was developed by the National committee for Quality Assurance to aid consumers with health-related issues with information to compare performance of clinical measures for health plans____

[Health Plan Employer Data and Information Set HEDIS] is a standardized set of performance measures designed to allow purchasers to compare the performance of managed-care plans

The final results of care, treatment, and services is terms of the patient's expectations, needs, and quality of lift, which may be positive and appropriate or negative and diminishing are included in what area of performance measurement?

[Outcomes] Healthcare performance improvement most focus on measuring performance in systems, processes and outcomes.

An established set of clinical decisions and actions taken by clinicians and other representatives of healthcare organization in accordance with state and federal laws, regulations, and guidelines is called:

[Standards of care] such as the codes of ethics, the criteria for accreditation, or the usual and common practice of similar clinicians or organizations in a geographical region.

What is the the purpose of National Practitioner Data Bank NPDB? created by the Health Care Quality Improvement Act of 1986.

The purpose of the NPDB is to provide a clearinghouse for information about medical practitioners who have a history of malpractice suits and other quality problems/to improve healthcare quality and reduce healthcare fraud and abuse.

During training, the employee should be____

Evaluated to make sure work is error free.

A coding supervisor who makes up the weekly work schedule would engage in what type of planning?

[Operational]

Performance standards are used to____

[Communicate performance expectations for how well the job will be done and how much work will be accomplished] this is one of the tool that can used to plan and manage staff resources. For example position description outline the work and qualification required by the job

A supervisor wants to determine if the staff are working at optimal(most desirable or satisfactory) output, how he/she can determine this?

Set productivity standards for the are at random times of the day to make sure that employees are at their desks and working.

When patient's record is missing in H&P at seven hours past this patient's admission time. This would be an example of ____

[Quantitative analysis] review for deficiencies is a review of the health record to determine its completeness and accuracy. Or to detect whether elements of the patient's health record are missing.

When review health record and found the physician stated on patient post-op note the documentation of "examined after surgery." this would be an example of _____

[Qualitative analysis] is a detailed review of a patient's health record for the quality of the documentation contained therein.

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