Chapter 21 - Clinical Quality Management Flashcards
Accreditation
- A voluntary process of institutional or organizational review in which a quasi-independent body created for this purpose periodically evaluates the quality of the entity’s work against preestablished written criteria. 2. A determination by an accrediting body that an eligible organization, network, program, group, or individual complies with applicable standards. 3. The act of granting approval to a healthcare organization based on whether the organization has met a set of voluntary standards developed by an accreditation agency
Accreditation Association for Ambulatory Health Care
A professional organization that offers accreditation programs for ambulatory and outpatient organizations such as single-specialty and multispecialty group practices, ambulatory surgery centers, college/university health services, and community health centers
Agency for Healthcare Research and Quality (AHRQ)
The branch of the US Public Health Service that supports general health research and distributes research findings and treatment guidelines with the goal of improving the quality, appropriateness, and effectiveness of healthcare services.
American College of Radiology
Accredits radiology facilities and offers accreditation programs in CT, MRI, breast MRI, nuclear medicine, and PET as mandated under the Medicare Improvements for Patients and Providers Act as well as for modalities mandated under the Mammography Quality Standards Act.
Benchmarking
The systematic comparison of the products, services, and outcomes of one organization with those of a similar organization; or, the systematic comparison of one organization’s outcomes with regional or national standards.
Care Coordination
The act of organizing patient care activities and sharing information among all of the participants concerned with a patient’s care to achieve safer and more effective care.
Case Management
- A process used by a doctor, nurse, or other health professional to manage a patient’s healthcare. 2. The ongoing, concurrent review performed by clinical professionals to ensure the necessity and effectiveness of the clinical services being provided to a patient.
Case Managers
A nurse, doctor, or social worker who arranges all services that are needed to give proper healthcare to a patient or group of patients.
Change Management
The formal process of introducing change, getting it adopted, and diffusing it throughout the organization.
Clinical Laboratory Improvement Amendments
Established quality standards for all laboratory testing to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the test is.
Clinical Pathways
A tool designed to coordinate multidisciplinary care planning for specific diagnoses and treatments
Commission on Accreditation of Rehabilitation Facilities
An international, independent, nonprofit accreditor of health and human services that develops customer-focused standards for areas such as behavioral healthcare, aging services, child and youth services, and medical rehabilitation programs and accredits such programs on the basis of its standards.
Conditions for Coverage
Standards applied to facilities that choose to participate in federal government reimbursement programs such as Medicare and Medicaid.
Conditions of Participation
The administrative and operational guidelines and regulations under which facilities are allowed to take part in the Medicare and Medicaid programs; published by the Centers for Medicare and Medicaid Services, a federal agency under the Department of Health and Human Services.
Credentialing
The process of reviewing and validating the qualifications (degrees, licenses, and other credentials) of physicians and other licensed independent practitioners, for granting medical staff membership to provide patient care services.
Emergency Medical Treatment and Active Labor Act (EMTALA)
A 1986 law enacted as part of the Consolidated Omnibus Reconciliation Act largely to combat “patient dumping” – the transferring, discharging, or refusal to treat indigent emergency department patients because of their inability to pay.
Evidence-Based Practice
The application of the best available research results (evidence) when making decisions about healthcare.
Explicit Knowledge
Documents, databases, and other types of recorded and documented information.
External Benchmarking
Comparison that occurs when an organization uses comparative data between organizations to judge performance and identify improvements that have proven to be successful in other organizations.
Healthcare Cost and Utilization Project (HCUP)
- A family of databases and related software tools and products developed through a Federal-State-Industry partnership sponsored by AHRQ. 2. HCUP databases are derived from administrative data and contain encounter-level, clinical and nonclinical information including all-listed diagnoses and procedures, discharge status, patient demographics, and charges for all patients, regardless of payer (such as, Medicare, Medicaid, private insurance, uninsured), beginning in 1988.
Healthcare Quality Improvement Act of 1986
A federal law that established standards and requirements related to peer review among physicians.
Health Data Stewardship
Pertain to responsibilities that best ensure appropriate use of health data.
Health Information Technology for Economic and Clinical Health (HITECH) Act
Legislation created to promote the adoption and meaningful use of health information technology in the United States. Subtitle D of the Act provides for additional privacy and security requirements that will develop and support electronic health information, facilitate information exchange, and strengthen monetary penalties.
Information Governance
- The accountability framework and decision rights to achieve enterprise information management (EIM) 2. IG is the responsibility of executive leadership for developing and driving the IG strategy throughout the organization; this encompasses both data governance (DG) and information technology governance (ITG)
Internal Benchmarking
Comparison used to identify best practices within an organization, to compare best practices within an organization, and to compare current practice over time.
Interprofessional Education
Occurs when two or more professions learn about, from, and with each other to enable effective collaboration to improve health outcomes.
Joint Commission
An independent, not-for-profit organization, the Joint Commission accredits and certifies more than 20,000 healthcare organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.
Leadership
Roles or functions that advance an organization towards meeting its goals; visionary thinking, decisions responsive to membership and mission, and accountability for actions and outcomes.
Medical Malpractice Liability
Refers to instances where a civil claim for damages against a healthcare provider successfully proves that the provider was negligent in their care of the patient leading to injury or death.
Medical Peer Review
The process by which a professional review body considers whether a practitioner’s clinical privileges or membership in a professional society will be adversely affected by a physician’s competence or professional conduct.
Medical Staff
The staff members of a healthcare organization who are governed by medical staff bylaws; may or may not be employed by the healthcare organization.
Medicare Prescription Drug, Improvement, and Modernization Act
Enacted to amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare program, to amend the Internal Revenue Code of 1986 to allow a deduction to individuals for amounts contributed to health savings security accounts and health savings accounts, to provide for the disposition of unused health benefits in cafeteria plans and flexible spending arrangements, and for other purposes.
Mission Statement
A written statement that sets forth the core purpose and philosophies of an organization or group; it defines the organization or group’s general purpose for existing.
National Practitioner Data Bank (NPDB)
- A confidential information clearinghouse created by Congress with the primary goals of improving healthcare quality, protecting the public, and reducing healthcare fraud and abuse in the U.S. 2. The NPDB is primarily an alert or flagging system intended to facilitate comprehensive review of the professional credentials of healthcare practitioners, healthcare entities, providers, and supplies.
Organizational Culture
- Refers to an organization’s norms, beliefs and values, or generally “how we do things here.” 2. What is felt by staff on any given day that is intangible but greatly influences how an employee feels about their job and the environment in which they perform it.
Outcomes and Effectiveness Research (OER)
The major objective of this is to understand the end results (outcomes) of particular healthcare practices and interventions.
Patient Protection and Affordable Care Act (ACA)
The product of the healthcare reform agenda of the Democratic 111th Congress and the Obama administration. The act is designed at increasing the rate of health insurance coverage for Americans and reducing the overall costs of healthcare.
Performance
The action or process of carrying out or accomplishing an action, task, or function.
Performance Improvement
The continuous study and adaptation of a healthcare organization’s functions and processes to increase the likelihood of achieving desired outcomes.
Plan Do Check Act (PDCA)
A performance improvement model developed by Walter Shewart, but was popularized in Japan by W. Edwards Deming.
Quality
The degree or grade of excellence of goods or services, including, in healthcare, meeting expectations for outcomes of care.
Quality Indicators
A standard against which actual care may be measured to identify a level of performance for that standard.
Quality Management
Evaluation of the quality of healthcare services and delivery using standards and guidelines developed by various entities, including the government and independent accreditation organizations.
Quality Professional
One who possesses a variety of knowledge and skills including those related to data analytics and information management, quality and performance improvement, leadership, and patient safety and risk management.
Tacit Knowledge
The actions, experiences, ideals, values, and emotions that tend to be highly personal and difficult to communicate (for example, corporate culture, organizational politics, and professional experience).
Telehealth
A telecommunication system that links healthcare organizations and patients from diverse geographic locations and transmits text and images for (medical) consultation and treatment.
Total Quality Management
A management philosophy that includes all activities in which the needs of the customer and the organization are satisfied in the most efficient manner by using employee potentials and continuous improvement.
Tracer Methodology
A process the Joint Commission surveyors use during the on-site survey to analyze an organization’s systems, with particular attention to identified priority focus areas, by following individual patients through the organization’s healthcare process in the sequence experienced by the patients. 2. An evaluation that follows (traces) the hospital experiences of specific patients to assess the quality of patient care; part of the Joint Commission survey process.
Triple Aim
Created by the Institute for Healthcare Improvement, this identifies that vast and systematic improvements are needed in order to improve experiences for patients in their pursuit of healthcare, enhance health among the population, and lower per capita costs.
Value-Based Payments
Any method of healthcare reimbursement that either financially incentivizes providers for good quality and outcomes or those that penalize providers for inadequate quality and unfavorable outcomes
Vision Statement
A short description of an organization’s ideal future state.
