Deck 11: Quality and Uses of Health Information

Question 1

Which of the following is NOT a secondary data pattern that the QIO will use to determine health care facility patient care trends?

A) Medically unnecessary care
B) Premature discharges
C) Incorrect DRG assignment
D) Total claim charges

Answer 1

Total claim charges

Question 2

Which of the following is an important process in the determination of the facility's compliance with documentation standards?

A) Physician profile review
B) Record review
C) Medication review
D) PDCA

Answer 2

Record review

Question 3

The term used to describe the continuous improvement of processes within a facility is:

A) QA
B) QM
C) PI
D) UM

Answer 3

PI

Question 4

The assignment of deemed status grants Medicare COP certification when a facility is accredited by which organization?

A) NCQA
B) TJC
C) NIAHO
D) Both b and c

Question 5

Accreditation varies from certification by which of the following?

A) Accreditation is voluntary.
B) Certification is voluntary.
C) Only accreditation is motivated by reimbursement.
D) Only certification is motivated by reimbursement.

Question 6

CMS reviews to inspect the quality of health care delivery and to address beneficiaries' concerns about the health care provider care are completed by:

A) NCQA
B) TJC
C) QIOs
D) DHHS

Question 7

Ensuring the documentation in a health record is complete is part of:

A) Quantitative analysis
B) Qualitative analysis
C) Utilization review
D) Case management

Question 8

Which of the following committees acts as a liaison to the governing board of the facility?

A) Surgical case review
B) P&T committee
C) Medical executive committee
D) Credentials committee

Question 9

Which of the following is an internal use of health information?

A) To develop health care products.
B) To influence national policy on health care issues through legislation.
C) To support and collect reimbursement.
D) To supply vital statistics to public health agencies.

Question 10

Which of the following is NOT a program used by CMS to ensure that insurance claims do not involve fraudulent medical coding?

A) MAC
B) MIC
C) HITECH
D) PEPPER

Question 11

Which example would a health care administrator use to improve HIM department quality?

A) The percent of records that are not complete within a 30-day period
B) The percent bed occupancy
C) The percent of patients who obtained a nosocomial infection
D) The average length of stay

Question 12

Which of the following is an external use of health information?

A) To support litigation.
B) To improve patient care.
C) Educate health care professionals and patients.
D) To provide data to managed care.

Question 13

Some HIM departments sometimes choose to perform concurrent review instead of retrospective review, most likely because:

A) Concurrent review is more time efficient.
B) Retrospective review is more time efficient.
C) Retrospective review cannot affect care for patients who have already been discharged.
D) Concurrent review cannot affect care for patients who have already been discharged.

Question 14

The committee often responsible for reviewing health care records according to accreditation standards, physician record completion statistics, and acting as a consultant to the director of health information management is the _______ committee.

A) HIM
B) Safety
C) Infection control
D) P&T

Question 15

Historically, HIM professionals have used _______________ to review the documentation of patient health care after the patient is discharged to determine whether patients received appropriate care.

A) Concurrent review
B) Performance improvement
C) Health information
D) Retrospective review

Question 16

Under what initiative do health care facilities transmit performance measures to TJC:

A) NPSG
B) HCQIP
C) SOW
D) ORYX

Question 17

To operate, the health care facility must obtain a license from:

A) The Joint Commission
B) AHA
C) NHQA
D) The state in which it is located

Question 18

Which of the following medical staff committees reviews medication usage?

A) Surgical case review
B) P&T committee
C) Medical executive committee
D) Credentials committee

Question 19

In the popular PDCA quality improvement method, which step of the process involves monitoring effectiveness of the solution over a period of time?

A) Plan
B) Do
C) Check
D) Act

Question 20

The predecessor of The Joint Commission was:

A) Hospital standardization
B) AHIMA
C) NCQA
D) ACS

Question 21

The method of reviewing patient information during hospitalization is known as _________.

Question 22

Each month the tumor registry personnel are required to report the ____________ of breast cancer for the facility. They report this statistic by determining the number of new cases of breast cancer for the month.

Question 23

A quality improvement effort regarding completion of the patient advance directive would require an _______________ team.

Question 24

__________ refers to disease within a population.

Question 25

Successful completion of a Medicare Conditions of Participation survey results in _________ for the health care facility.

Question 26

___________ is a quality improvement technique used to elicit participation and information from an entire group.

Question 27

Health information may be used in ___________to support the plaintiff's claim.

Question 28

To improve quality according to a standard, a health care facility may use ___________, the comparison of itself to a similar or superior performer.

Question 29

A method used to effectively manage patients during their hospitalization is known as _______________.

Question 30

A predetermined course of treatment for a patient with a particular diagnosis is known as a ______________.

Question 31

Which of the following is an example of the display of timely health information?

A) A patient's laboratory results that need to be filed in the patient's paper record at nursing station 3
B) A patient's laboratory results that were entered into the patient's electronic health record
C) Dr. Johnson had to call the medical clinic out of state to get the patient's previous x-rays
D) A radiology report that was not filed in the chart of a patient who was discharged 42 days ago

Question 32

Health information may be analyzed to support a _________ campaign to promote the facility within its community.

Question 33

A supervisor and her team of employees are confronted with two solutions to a problem. Each solution involves time, money, and space. The supervisor might use a quality management tool called a ___________.

Question 34

Ensuring that data is collected the same way each time it is collected is an example of:

A) Data precision
B) Data consistency
C) Data currency
D) Data Timeliness

Question 35

How is the Healthcare Effectiveness Data and Information Set (HEDIS) used?

A) The CDC uses it to collect morbidity data and inform public health decisions
B) Patients can access the data on a website and use it to choose a doctor
C) Employers and health insurance companies use it to negotiate employee group insurance plans
D) CMS uses it to determine the effectiveness of EHR technology

Question 36

A quality improvement effort regarding scanning of loose reports would require an ___________ team.

Question 37

A __________ chart is useful for organizing the results of a brainstorming session.

Question 38

The PI methodology called ___________ seeks to improve a process by eliminating waste and inefficiency.

Question 39

____________ is a group of like elements compiled to provide information about the group.

A) Meaningful use
B) Aggregate data
C) Electronic health record
D) Incidence

Question 40

Managed care insurance policies require health care facilities to provide the following information EXCEPT:

A) Average length of stay
B) Patient care outcomes
C) Patient marital status
D) Facility services provided

Question 41

The number of existing cancer cases reported by the tumor registry is known as _______.

Question 42

List three appropriate requests for health information from an entity outside of the health care facility.

Question 43

What is the difference between mortality and morbidity?

Question 44

The ______________ process would be initiated following a patient's fall from the bed, to gather information and coordinate the claim.

Question 45

According to CMS, a ____________ is designed to reimburse acute care hospitals with a value-based incentive, "based either on how well the hospitals perform on certain quality measures or how much the hospitals' performance improves on certain quality measures from their performance during a baseline period."

Question 46

Discuss the difference between quality assurance and quality improvement.

Question 47

What is the NCQA and its mission?

Question 48

Physicians may perform _______ to determine the cause or best treatment for a particular disease.

Question 49

Monitoring functions for compliance within set standards is called __________, which also requires action to correct noncompliance, and followup on the correction.

Question 50

List and explain how the committees in a health care facility use health information.

Question 51

Match the following figures and tables with their definitions.
a.
b.
c.


1. Bar chart
2. Survey
3. Line graph
4. Decision matrix
5. Pie chart

Question 52

How has HITECH legislation affected the use of health data to improve patient care?

Question 53

Ensuring appropriate, efficient, and effective patient care is a process of ___________.

Question 54

A thorough review of the patient's health information to determine pertinence, appropriateness, or compliance with standards is _________.

Question 55

Compare and contrast the difference between prevalence and incident. Why is it important to know both?

Question 56

Define and explain the three quality management theory methods.

Question 57

The review of the record performed postdischarge is known as _________.

Question 58

Why is quality measurement important in health care? Who are some customers of health care quality? How are accreditation and quality linked?

Question 59

TJC continued to promote quality by establishing _______ in 2002 for health care facilities. These goals recommended measures to reduce patient falls and health-care related infections.

Question 60

The level of detail with which data is collected is known as __________.

Question 61

How can effective documentation of past patient care affect future patient care management?

Question 63

Who was W. Edward Deming and what was his quality management theory? Discuss his quality management principles.

Question 64

What is a decision matrix and how can this tool be useful in effective decision making?

Question 65

List at least five of the HIM functions that must be completed in a timely manner to ensure quality assurance.

Question 66

Compare and contrast Juran's and Crosby's quality management theories. How can health care facilities apply these theories?

Question 67

Compare and contrast the Lean and Six Sigma performance improvement methods. How can health care facilities apply these theories?

Question 68

Why did health care facilities need to establish quality standards in patient care? Which two organizations began to assist in establishing patient care standards in hospitals?

Question 69

How do the Quality Improvement Organizations determine the level of care provided by health care facilities?