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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
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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.
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Stack #404189
| Question | Answer |
|---|---|
| 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 |
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RHIT2010