73 terms

HIM 120 Test II

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
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?
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?
Which of the following is a data collection tool that records and compiles observations or occurences?
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?
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?
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?
which organizaton sponsors HEDIS reporting system?
Which of the following organizations provides the most complete vew of managed care plan quality?
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.
are JC's standards for improving patient safety
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
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
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
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
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
plotting the points for two variables to determine whether they are related to each other
scatter diagram
displaying frequencies of responses
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