What process assist a health care facility in continuously looking at the ways that problems develop and seeking ways to prevent problems form happening?
Performance impovement
What information would you report for each physician if you are asked for record completion statistics for specific physicians who are being evaluated for reappointment to the med staff
number of delinquent records
With the passage of medicare (Title XVIII of the social security act) in 1965, which of the following became manditory
A. Quality improvement
B. Risk management
C quality Assessment
D. utilization review
D. utilization review
The med malpractice crisis of the 1970s prompted the development of __________ in health care facilities
policy and procedures should represent the normal course of business
The hospital quality department adopted the Lean management quality model using JIT, which ensures requred process items and resources are
available at the right place and the right time
You are required to maintain a min of 94.5% accuracy in coding. the past year average accuracy average was 95.3% The QI plan allows for a Standard Deviation +-2 against best practices of 97% accuracy. Did you meet the range
No, because it is below +- 2 SD
Surgical case review includes all of the following
Determination of surgical justification based on the clinical indications in cases where no tissue has been removed
cases where there is a significant discrepancy between preop, postop, and path diagnosis
cases with serious surgical complications
Joint commission requires that medical record review be performed to evaluate adequacy, accuracy, completeness, and quality of documentation
on an ongoing basis
patient morality, infection and completion rates, adherence to living will requirements, asequate pain control, and other docs that describe end results of care or measurage changes in the patients health are examples of
outcome measures
as based in case law decisions and the Joint commission standards, who is ultimately responsible
governing body or board of trustees
which quality management theorist focused on zero defects as the goal of performance improvement efforts
Crosby
which quality management theorist believed that merit raises, formal evaluation, and quotas established through bench marking hinder work productivity and grow
W. Edwards Deming.
Analysis used to identify the variable that helps and the variables that hinder reaching the desired outcome or solution to the problem. In addition to identifying causal order, IT estimatess the relative effect of each process variable on outcome variable.
Force Field Analysis
The joint commission requires health care facilities manage the environment of care by implementing seven (7) various safety plans, which must be evaluated at least?
annually
They type of indicator about the placement and number of fire extinguishers would a
structure
Your hospital is required by the joint commission and CMS to participate in national bench-marking on specific disease entities for quality of care measurement. This required collection and reporting of disease-specific data is considered
a series of core measurements
The manager of the utilization review department wants to monitor and evaluate the prevention of inappropriate admissions. When would the manager need to collect the data
prospective review
Prospective Review
Before a patient receives services - i.e. prior authorizations and to prevent inappropriate admissions
Concurrent Review
at the time of admission and through out their stay- to determine if the same level of services is required and when is should be discontinued
Retrospective Review
After care has be rendered - can provide valuable information about undesirable practices and to help improve future processes
Which of the following data sources would be considered an example of an external source?
D. quality improvement organization QIO information
Are meeting minutes from the medical records review committee admissible in court
No
The board of directors of a 400 bed women's hospital receives a report of key quality indicator results on a periodic basis. The report includes the qrty c-section rates. This reporting period , they see a raise in the rate and want to know why. what is the best QI tool for this
Control chart
what quality indicator would identify improvement needs in hospital electronic transmission of health care claims and remittances to allow interoperability with ICD-10 codes
an increase in 5010 rejections
Historic accomplishments impacting quality in medical care include all except
B. implementation of OTRA
accreditation agency for managed care organizations
NCQA
Quality requirements of providers participating in the medicare program are found in all except
ORYX
Which data bank is a result of HIPAA legistrations
Health Care integrity and protection data bank
Who do you have to go through if you are including human subjects in a clinical trail
IRB institutional Review Board
The joint commission on-site survey process incorporates tracer methodology which emphasizes surveyor review by means of
