HIM 229 Chap10 Test 2 part 1

rad2329's version from 2017-07-21 19:01

Section 1

Question Answer
*What does shared leadership meanall organizations ensure that all employees participate in an integrated, continuous PI program.
If problems exist in the organization who is ultimately responsible?board of directors
**What are the 3 basic responsibilities of the PI or quality management department efforts?Identify potential quality problems. - Take the tools and Assist them with those tools. determination of the best methods for studying potential problems. - Participate in regular meetings to communicate with each other.
What is a StandardA written description of the expected features, characteristics, or outcome.
**What are the 4 types of standards that are relevant in healthcare QI or PI?Clinical practice guidelines & clinical protocols - Accreditation Standards - Governmental regulations - Licensure requirements.
*clinical practice guidelines & clinical protocols are _____Step ty step guidelines (protocols) to used by healthcare practitioners to make knowledge based clinical decisions directly related to patient care
*Accreditation standards are _____Prediefined statements of the criteria against which the performance of participating healthcare organizations will be assessed during the voluntary accreditation process. Based on data collection & submission process. (DNV & Joint Commission are accreditation organizations).
*Government regulations are _____Detailed descriptions of the compulsory requirements for participation in the federal Medicare & Medicaid programs.
*Licensure requirements are ___Detailed descriptions of the criteria healthcare organizations must fulfill in order to obtain & maintain state licenses to provide specific healthcare services.
Outcome measures document ____the results of care for individual patients as well as for specific types of patients grouped by diagnostic category (exp. acute care hospital's overall rate fo post surgical infection)

Section 2

Question Answer
What is the purpose of national patient safety goals (NPSGs)Focus on patient safety goals to improve patient safety. Goals focus on problems in healthcare safety and how to solve them.
*What are some of the National patient safety goals that the joint commission requires a comprehensive presurvey data collection & submission process focusing on?Use alarms safely - identify patient safety risks - prevent infection - prevent mistakes in surgery
Tracer methodology is ?Used to identify quality & patient safety issues. An evaluation method in which surveyors (i.e. joint commission employee), select a patient, resident or client & use that individuals record as a roadmap to move through an organization to assess & evaluate the organization's compliance. they "follow a patient, resident or client from the beginning of care all the way through the end of the care to include waste disposal and charting.
Joint commission is not the onlyaccrediting agency.
Government regulations & licensure requirementsMedicare conditions of participation, and medicaid
To participate in the medicare program, healthcare providers must compoly with federal regulations known asCOP (Medicare conditions of participation) It outlines everything that deals with medicare
Medicare recognizes some accreditation organization as having standards that sufficiently cover the related COP. This is known as ______Deemed status (i.e. if you are Joint Commission, DNV, etc. certified) (on page 72)
Peer review organizations (PROs) also known as Health Care Quality Improvement Program (HCQIP)assist the federal govt in monitoring quality of care.
The PRO *HCQIP) was developed to ____Develop Quality indicators, Encouraged communication with professionals & providers, Forster quality improvement through system improvements,
What are some of the areas the QUOs focus on?Acute myocardial infarction, breast cancer, diabetes, heart failure, pneumonia, stroke

Section 3

Question Answer
Standards of organizational quality in healthcare: What is the 4th standard of clinical quality assessment?State & Local licensure. (Some states / local localities may have different requirements)
Standards of organizational quality in healthcare: What is the 3rd standard of clinical quality assessment?Government regulations: Detailed descriptions of the compulsory requirements for participation in federal Medicare and Medicaid programs
*Standards of organizational quality in healthcare: What are the 4 types of standards that are relevant within the contest of clinical quality assessment:1. Clinical practice guidelines and clinical protocols. 2. Accreditation standards. 3. Government regulations. 4. Licensure requirements
Standards of organizational quality in healthcare: What is the 2nd standard of clinical quality assessment?Accreditation standards: Predefined statements of the criteria against which the performance of participating healthcare organizations will be assessed during the voluntary accreditation process
Standards of organizational quality in healthcare: What is the 1st standard of clinical quality assessment?Clinical practice guidelines and clinical protocols: Detailed step by step guides used by healthcare practitioners to make knowledge-based clinical decisions directly related to patient care.
*Define Utilization review.Process of determining whether the medical care provided to a specific patient is necessary.
*In most hospitals, UM (Utilization Management) programs perform what 3 important functions?Utilization review - Case management - and Discharge planning
What are the 3 ways UR can be performed?Prospectively, before care is provided - Concurrently, while care is being provided - Retrospectively, after the episode of care is complete
What is the best or most efficient way to service a patient?Intensity-of-service screening criteria determines whether the patient's needed services could be fulfilled most efficiently in an inpatient hospital setting or safely provided on an outpatient basis.
What is preadmission utilization review?it is conducted to determine whether the planned service (intensity of service) or the patient's condition (severity of illness) warrants care in an inpatient setting.

Section 4

Question Answer
What is Continued-Stay / or concurrent) utilization review?it is conducted to determine whether the patient continues to require inpatient care. (Purpose is to ensure LOS is not being unnecessarily prolonged and that the hospitals resources are being used efficiently)
What is retrospective utilization review?It is conducted after the patient has been discharged. Reviews the medical necessity of the services provided to the patient. Conducted by a peer review organization or hospital committee. It evaluates quality, cost and LOS factors.
What is case management (the 2nd part of Utilization management)Makes sure services are necessary & effective. It is the ongoing review of clinical care to ensure the necessity and effectiveness of the services being provided to the patient. ( does the patient still need to be here).
*What is Discharge planning (the 3rd part of Utilization management)ensure that patients are released from acute care hospitals when they no longer need inpatient care and that if services at a lower level of care are necessary, the patient is referred to that level. (usually managed by the patients case manager).
*What is Risk?Any occurrence or circumstance that might result in a loss.
*What is the purpose of a risk management program?To have in place to minimize any risk.
**What are the three components of risk management (The basic functions)1. Risk identification and analysis 2. Loss prevention and reduction 3. Claims management
In risk identification and analysis what is the role of the risk manager?To identify any typ of risk by collecting and analyzing information on actual losses and potential risks to design systems that lessen potential losses in the future.
Name a few sources of risk management information?Incident reports (Occurrence reports/Occurrence screens) - Performance improvement reports - Results from patient satisfaction surveys - Current and past liability claims - Complaint reports
*What is an incident/occurrence report?A legal document used to identify potentially compensable events. (It is negative)

Section 5

Question Answer
*What is Loss prevention and reduction?The risk manager is responsible for developing systems to prevent injuries and other losses within the organization.
*What is claims management?The organizations response to any injury claims sought by patients.
***What is patient advocacy?A patient representative (ombudsperson) responds personally to complaints from patient and their families. (Assists with patients)
*What is a sentinel event?An event that could have or did result in a life threatening event. (Serious physical injury or death)
The joint commission requires healthcare organization to do what regarding a sentinel event?Conduct in-depth investigations of occurrences that resulted or could have resulted from in life threatening injuries to patients, medical staff, visitors, or employees
*What was proposed in the Affordable Care Act of 2010?An Accountable Care Organization (ACO) is a network of doctors and hospitals that shares the responsibility for providing car to patients.
An ACO would agree to manage _____all of the healthcare needs of a minimum of 5,000 Medicare beneficiaries for at least 3 years.
*What is Six Sigma?A way of using statistics to look at variations and processes (Upper and lower charts). It uses statistics for measuring variation in a process with the intent of producing error-free results.
*What is a Virtuoso team?Subject matter experts in a particular field put together to work on ambitious goals

Section 6

Question Answer
*What is ISO 9000 certification - ISO 9000 does what?Sets specification standards for quality management with regard to process management and product control. (It is international and is a Process/Product control system)
What is utilization management?A group of processes that determine the appropriateness of medical services
What should be performed when a patient has been discharged prior to an administrative utilization review being conducted?Retrospective utilization review
A patient is dissatisfied with his or her care. Who should the patient contact at the hospital?Patient representative/advocate
A woman dies in labor the Joint commission would call this type of outcome ?A sentinel event
QIOs use peer review, data analysis and other tools to ?Evaluate whether or not a healthcare facility is meeting standards for accreditation and licensing
Shared leadership means?Employees are participants in the performance improvement program
The NPSG scores organizations on areas that?Commonly lead to patient injury
Accreditation standards were develop to standardize ____Quality of healthcare
What is the mission of the AHRQ?To improve quality, safety, efficiency, and effectiveness for all Americans

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