Domain V – Quality (12%)

1. Domain V – Quality (12%) RHIT Prep Workshop Test Year 2014

2. Clinical Quality Terms Adverse Event = medical intervention with an unexpected result Benchmarking = comparisons of performance to establish one standard or performance or best practice Compliance = meeting prescribed set of standards or regulations

3. Clinical Quality Terms Error = unintended act [omission or commission] Performance Improvement = activities designed to increase existing level of efficacy and efficiency Performance Measure = a tool used to compare performance to a specified process or outcome Quality = level of excellence; exceeding customer [patient] expectations

4. Clinical Quality Terms Quality Assurance = activities designed to measure level of quality in order to maintain set standards Quality Assessment = the act of measuring and evaluating activities to determine level of quality Quality Control = activities designed to identify variances with existing performance levels to ensure quality outcomes

5. Clinical Quality Terms Quality improvement = activities designed to increase the quality of a service or product Quality Management = coordination of quality activities necessary to achieve quality outcomes Sentinel Event = an unexpected occurrence with serious negative outcomes that should not have happened; also known as a “never event”

6. Clinical Quality Terms Root Cause Analysis= process to identify the causative element underlying performance variations Safety= occurrences related to care or lack of care that resulted, or could have resulted, in harm to a patient Total Quality Management = an organizational philosophy based on CQI (Continuous Quality Improvement) performance improvement models

7. Practice Question #1 A standard of performance or best practice for a particular process or outcome is called ____. Performance measure Benchmark Improvement opportunity Data measure

8. Practice Question #2 A quantitative tool that provides an indication of an organization’s performance in relation to a specified process or outcomes is called ___. Performance measure Improvement opportunity Team-based process Data measure

9. Quality Improvement Methods and models for performing, assessing, and building quality into health care services • Internal • Organization’s vision, mission, goals • External • Professional standards

10. Quality Improvement • TJC [The Joint Commission] • Standards relating to quality improvement • CARF [Commission on Accreditation of Rehabilitation Facilities] • Responsible for evaluating quality of care in organizations providing rehabilitative treatment • QIO [Quality Improvement Organizations] • Peer reviews

11. Quality Improvement • AAAHC [Accreditation Assoc. for Ambulatory Health Care ] • Assists ambulatory care facilities to improve quality • ACS [American College of Surgeons] • Review standards in health care practices • NAHQ [National Assoc. of Healthcare Quality] • Certifies health care professionals in CQI

12. TJC Core Measure Criteria Sets AMI [Acute Myocardial Infarction] aka heart attack Heart Failure Pneumonia Surgical infection prevention

13. Deming Quality Principles Build quality into the product Create consistency toward purpose Focus on quality process flow rather than mass inspection Embrace long-term relationship, trust, loyalty, and honesty Constantly asses and improve processes

14. Deming Quality Principles Institute on-the-job training, job orientation, continued education, equipment training, etc. Institute leadership Drive out fear Improve communications

15. Deming Quality Principles Eliminate numerical quotas Eliminate quick-fix solutions Eliminate inconsistent slogans Create an open atmosphere of creativity Involve everyone in working toward improvement in organization

16. Pareto Principle “20% of a problem’s sources are responsible for 80% of its actual effects” That is…by focusing on a few key sources, the team can eliminate a large number of problematic outcomes

17. Donabedian’s Classes of QA • Structural indicators: Policies & Procedures • Provider characteristics • Physical and organizational resources • Process indicators: Peer Review of Records • Interactions between patient and providers • Investigate processes that guide operational decisions • Outcome indicators: Mortality Rate • Review outcomes

18. Practice Question #3 Which of the following is not one of TJC core measure criteria: ___ A. Heart failure B. Acute myocardial infarction C. Diabetes mellitus D. Pneumonia

19. Practice Question #4 W. Edwards Deming believed that quality must be built into the ___. Job title Employee evaluations Product Organizational hierarchy

20. Practice Question #5 According to the Pareto Principle… 20% of the sources of a problem are responsible for 20% of its effects 80% of the sources of a problem are responsible for 20% of its effects 20% of the sources of a problem are responsible for 80% of its effects 80% of the sources of a problem are responsible for 80% of its effects

21. Practice Question #6 Donabedian proposed three types of quality indicators: structure indicators, process indicators, and ___. Performance indicators Outcome indicators Management indicators Output indicators

22. Organizing the Data • Cause-and-Effect Diagrams • Fishbone diagrams separate root causes • Check Sheet • Identifies how often an event occurs • Decision Matrix • Allows for scoring each alternative to prioritize objectives • Flow Chart • Identifies work redundancy, inefficency

23. Performance Improvement Plans Creating a continuous cycle of improvement Statement of mission Statement of vision Objectives Organizational values and culture Leadership

24. Performance Improvement Plans Organizational structure Performance measure objectives Methodology for improvement Annual review plan Communication models

25. Practice Question #7 A key feature of performance improvement is ___. Replacing unstructured decision-making Developing managers to control processes An endless loop of feedback A continuous cycle of improvement

26. Practice Question #8 Performance standards are used to ___. Communicate performance expectations Assign daily work Describe the elements of a job Prepare a job advertisement

27. CQI Continuous Quality Improvement A team approach to improvement that rewards the group when things get better instead of encouraging a culture of blame if things go wrong

28. FOCUS Find a process to improve Organize to improve a process Clarify what is known Understand variation Select a process improvement

29. PDCA Plan Investigate the process; collect and analyze data; design improvement Do Implement the plan of action Check Evaluate design; analyze results; redesign if needed Act Continue or revise plan

30. Utilization Management AKA Utilization Review Method of controlling costs and quality of care by reviewing appropriateness and necessity of care provided to patients. Used to assure staff uses resources in the most cost-effective manner

31. Utilization Review Process • Preadmission review • Determine medical necessity and appropriateness • Admission review • Determine medical necessity and appropriateness • Concurrent review • Review medical necessity for tests and procedures ordered during an inpatient admission

32. Utilization Review Process • Discharge review • Determine compliance with specific discharge screen criteria • Retrospective review • Evaluation of quality issues, cost and outliers issues and issues of utilization management and appropriateness of care

33. Practice Question # 9 Which of the following is not a responsibility of a healthcare organization’s quality management department? Helping departments to identify potential clinical quality problems Participating in regular dept meetings across the organization Conducting medical peer review to identify patterns of care Determining the method for studying potential problems

34. Risk Management Management of any event or situation that could potentially result in an injury to an individual or financial loss to the health care organization. The creation of policies and procedures that reduce risk

35. Risk Management • Risk Identification • Identify areas of existing or potential loss • Risk Control • Prevention and control of risk events • Reducing number of risk events • Risk Financing • Fund to financially cover losses

36. Risk Management Loss prevention and reduction Claims management Safety and security Employee programs Patient relations

37. Sentinel [Never] Events Unexpected situation involving patient death or serious physical or psychological injury Surgery on wrong patient Infant discharged to wrong family Blood transfusion with incompatible blood Surgery on wrong anatomical site Infant abduction

38. Practice Question #10 Every healthcare organization’s risk management plan should include the following components except ____. Loss prevention and reduction Safety and security management Peer review Claims management

39. Practice Question #11 Which of the following should be the first step in any quality improvement decision-making process? Analyzing the problem Identifying the problem Developing alternative solution Deciding on the best solution

40. Practice Question #12 Which of the following is not a step in quality improvement decision-making? Determination of the quickest solution Definition of the problem Development of alternative solutions Implementation and follow-up

41. Credentialing Reviewing, verifying, validating, and evaluating key factors that determine practitioner’s ability to fulfill patient care responsibilities

42. Credential Verification Education Current licensure in your state Liability insurance coverage Clinical competence Satisfactory health status

43. Confirmation • National Professional Organization • Verify status of the credential • National Practitioner Data Bank • Malpractice lawsuits filed • Disciplinary actions taken • Quality of care • Credentialing information from other facilities

44. Practice Question #13 Establishment of the National Practitioner Data Bank gave the federal government in malpractice issues and _____. Employment of physicians Quality of care Licensure of physicians Pay for performance

45. Practice Question #14 Which of the following actions is not included about a physician in the National Practitioner Data Bank? Malpractice lawsuits Disciplinary actions Credentialing information from other facilities Personal bankruptcy

46. Practice Question #15 A national professional organization that is dedicated to a specific area of healthcare practice can confer a physician’s status of ___. Credential Certificate License Degree

47. REview Questions

48. Practice Question #16 What process assists a health care facility in continuously looking at the ways that problems develop and seeking ways to prevent problems from happening in the future? Risk management Quality control Utilization management Performance improvement

49. Practice Question #17 You are asked for record completion statistics for specific physicians being considered for reappointment to the medical staff. You will create a report showing ____. Physician education and training Sate licensure expiration date Number of delinquent records Prior malpractice claim history

50. Practice Questions #18 The primary source document used in quality assessment monitoring is the ___. Admission and discharge register Health record Procedure index Diagnosis index