Jb Chapter 5
Terms in this set (36)
The purposes of PROs include determining all of the following except whether:
:the health care facility had met accreditation and licensing standards.
During a quality improvement audit, it was noted that a medical record coder was consistently up-coding certain diagnoses. The facility is conducting investigations to determine how much money to reimburse its third-party payers for overpayment. All of the following departments would receive data about the investigation except the _______________ department.
What does affinity grouping do?
Organizes similar ideas into logical groupings
Which of the following organizations was a forerunner for the evaluation of quality medical care in health care organizations?
The Joint Commission (TJC, formerly JCAHO)
Jola is a 13-year-old patient of Dr. Welch at Houston Hospital. Houston Hospital has implemented electronic health records. At Jola's discharge, due to downtime, a manual medication script was generated and filled at the hospital, along with a discharge summary and patient instructions that were given to the patient's family member by the discharging nurse. The patient's condition got worse and she returned to the hospital within 48 hours of discharge. Investigation revealed that the patient was discharged home with the wrong medication. Which of the following might potentially be responsible?
ALL OF THE ABOVE
Jackie is a patient of Dr. Tracy at Jefferson Hospital. Nurse Sue reviewed with Jackie the most accurate list of all medications she currently taking (including prescribed and non-prescribed drugs, vitamins, herbs, and nutritional supplements). She then compares the list against Dr. Tracy's admission, transfer, and discharge orders. Which of the following functions was Nurse Sue performing?
What action(s) would assist the manager of the health information management department in improving customer perception of the quality of services provided by the department?
Identify the specific customer needs in order to improve customer satisfaction with services
At most, TJC accreditation is granted for ___ months
During the credentialing process, the applicant was granted active membership. The applicant can utilize the clinical privilege for a maximum period of how long?
2 years or fewer
The National Guideline Clearinghouse (NGC) provides:
clinical guidelines that are mandated by the federal government
Risk management is the:
process of overseeing the medical, legal, and administrative aspects of health care management.
Which of the following functions became mandatory under Title XVIII of the Social Security Act?
In 1965, which of the following established legal liability for hospitals?
Darling vs. Charleston Community Memorial Hospital
Which of the following is NOT a quality improvement component?
IRB approval is required
Nurse Bob wants to use the screening criteria for utilization review that most health care facilities utilize to determine the need for inpatient services and justification for continued stay. Which of the following should he use?
Severity of illness
Bob, who is the manager of the utilization review department, wants to monitor and evaluate the prevention of inappropriate admissions. When should Bob collect data?
Which of the following systems can the hospital query to identify quality of care of a prospective applicant?
National Practitioner Data Bank
What will be the most effective data presentation tool to use in comparing staff productivity?
To decrease risk exposures in a health care facility, which of the following can be used to track and document incidents?
In order to assure that patient care problems can be remedied immediately, Nurse Bob should perform which type of quality data collection?
Which of the following utilization review activities is being performed when a patient's record is reviewed at regular intervals to determine the appropriateness of care rendered and bed utilization?
Congress passed which of the following programs to mandate medicare cost control?
The members of which group are responsible for recommending clinical privileges to the governing body?
Which of the following describes project life cycles for managing performance improvement?
Initiation, Planning, Execution, and Closure
As related to quality patient care, physicians who are members of the ambulatory care clinics meet monthly to review documentation of treatment plan and patient outcomes. This type of review, in which a physician's health care documentation is reviewed by his/her professional colleagues, is known as what?
The manager of the utilization review department wants to identify patients who are not suitable for inpatient admission and then redirect them to an appropriate health care setting to obtain health care services. When would the manager need to collect data?
To ensure the patient will leave the hospital as scheduled, effective discharge planning begins at which of the following?
Physician members of the psychiatry committee meet to review psychology cases that are referred for quality issues and that deviate from the Houston, Texas area standards of care. This type of review, in which a physician's record is reviewed by his or her professional colleagues, is known as what?
Certification can be described as
Granting approval for healthcare organization to provide services to a specific group of beneficiaries
The purpose of _________________ was to establish a continuous, datadriven accreditation process that uses performance measures and data focused on core measures
What type of data collection tool will be useful in collecting the number of charts reviewed for coding accuracy, the type of errors, and the number of errors made by each coder?
Which of the following is not a type of idea-generation technique?
Which of the following processes is not mandatory for health care facilities?
In order to receive reimbursement for treating Medicare and Medicaid patients, health care organizations must:
meet the federal conditions of participation.
In a health care facility, who is responsible for the appropriateness and assurance of quality care?
What does brainstorming do?
Generates a large number of creative ideas from a group
A review process conducted at the request of a healthcare facility seeking accreditation or certification is an example of which of the following review types?
Dr. Jefferson contacted another healthcare organization to schedule an episode of care service for her patient, Francis. The healthcare case manager reviewed Francis's projected needs with Dr. Jefferson, and admission criteria were established on the basis of a suggested diagnosis. The case manager then contacted the patient directly to obtain more information. The case manager also contacted a third party payer to confirm they would pay for Francis's service. What function is the case manager performing?
TEFRA caused the reimbursement structure to change from a:
retrospective to a prospective payment system.
The national safety goal was established
to reduce errors in healthcare
The goal of clinical practice guidelines is to:
standardized clinical decision making
Which of the following terms refers to the process of planning for change?
Which agency requires that providers and organizations develop, implement, and maintain an effective organization-wide, data-driven quality assessment and performance improvement program?
Conditions of Participation
The clinician failed to obtain a signed consent form from Bob prior to surgery. His attorney may argue that Bob is a victim of:
assault and battery
________ is an effective tool that can be used if a more quantitative approach is required during a project planning, because it can identify those activities that must be completed on time in order for the entire project to meet its final deadline.
Health care performance improvement philosophies most often focus on all the following performance measurements EXCEPT
Which of the following is not the role of a HIM professional in a quality improvement process?
Validate Clinical Data
The utilization manager reviews the record to determine which health care setting will be appropriate for the identified procedure. Which of the following functions is the manager performing?
The Joint Commission specifies that all of the following aspects of performance standard must be routinely evaluated, except:
Which of the following is a multidimensional evaluation tool that can be used to organize and categorize information into a more usable form for selecting the best possible improvement to the existing process?
Which of the following is not a research related framework?
Does not require subjects consent
Utilization management is the:
group of processes used to measure how efficiently health care is managed.
All of the following are methods that can be used in monitoring data quality EXCEPT
A physician accidentally prescribed the wrong medication to a patient, which caused the patient to be in a coma for 3 days. Which of the following court actions can the patient seek?
Negligence and malpractice
Who is responsible for Healthy People 2020?
ODPHP within DHHS
Which of the following data organization methods is a tool that can be used to organize, categorize, and reduce information to a more usable form?
Nominal group technique
Which of the following methodologies does the Joint Commission typically use during an on-site survey as they follow selected patients through the continuum of care in order to analyze organizational efficiency?
Which of the following is a sequential representation of steps in a decision making process?
Which of the following can be used to show the frequency for each interval or category of nominal, ordinal, and discrete date?
Nurse Bob wants to display goals for patients and provide the corresponding ideal sequence and timing of staff actions to achieve those goals with optimal efficiency. Which should he use?
An attorney subpoenas the quality improvement committee meeting minutes of Houston Community Hospital. Should the minutes be released?
No, because quality improvement committee meeting minutes are protected from subpoenas
The utilization review coordinator reviews inpatient records at regular intervals to justify necessity and appropriateness of care to warrant further hospitalization. The utilization review activities being performed constitute a:
Which department will most likely be responsible for taking corrective action regarding the following quality indicator? "Ninety-five percent (95%) of physician appointments/reappointments will be completed within 90 days of receipt of all required application materials."
You are assisting the nursing department in writing indicators to determine appropriate ratios and formulas and to determine data collection time frames. One important aspect of care is the documentation of patients' education. More specifically, the nursing department would like to assess its documentation of education on colostomy care for patients with new colostomies. Concerning the preceding scenario, what would be the most effective time frame for collecting the requested data?
was developed to publicly report valid information about the quality of care delivered in the nation's hospitals.
The CMS also contracts with non-governmental agencies across the country to monitor the care provided by independent healthcare practitioners. What are these agencies called?
Quality Improvement Organizations
A pert chart is also known as
critical path method
Staff members are frustrated with the way phone messages are handled in your clinic. All incoming calls go to a designated staff person on the unit, who then places a handwritten note in the provider's mailbox. These notes are not always legible, and staff members are too busy to check their mailboxes more than once a day. These issues result in delayed responses to urgent messages, low patient satisfaction, and missed deadlines. From the options provided, determine which quality improvement model you should use to improve this situation.
Plan for improvement, do the improvement, check the results of action, and act on the evidence
To monitor and improve customer satisfaction, an organization must know all of the following EXCEPT
The number of competitors within their geographic area
Which of the following tools can best be used to compare one's performance to high quality performers?
Under which of the following statutes must a health care facility report certain diseases and medical events such as suspected child abuse to various data banks?
State and Federal Statutes
Which of the following questions is most focused on quality assurance?
Which staff member failed to track the chart to the correct station?
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