chapter 3 : Quality of Care Measures and CDI Endeavors

Question 1

O/E ratio

Answer 1

Observed - to -expected (O/E) mortality rate

observed mortality: actual number of patients who died in the hospital each month

expected mortality: expected average number of deaths

Question 2

O/E equal to 0.75

versus

O/E equal to 1.5

Answer 2

25% lower than expected
versus
50% higher than expected

Question 3

Is PSI 04 included in PSI 90

Answer 3

No.
PSI 04 (Death rate among surgical inpatients with serious treatable conditions) is not included along with PSI 02 (Death rate in low mortality DRGs) , 05 (Retained surgical item or unretrieved device fragment rate), 07 (Central venous catheter - related bloodstream infection rate), 16 to 19.

Question 4

PSIs included in PSI 90

Answer 4

10 namely,

03: Pressure Ulcer rate
06: Iatrogenic pneumothorax rate
08: In- hospital fall with hip fracture rate
09: Perioperative hemorrhage or hematoma rate

10: Postoperative acute kidney injury requiring dialysis rate

11: Postoperative RESPIRATORY FAILURE

12: Perioperative pulmonary embolism or DVT rate

13: Postoperative Sepsis rate

14: Postoperative Wound Dehiscence rate

15: Abdominopelvic accidental puncture or laceration rate

Question 5

True or False: Conditions that develop during an outpatient encounter, including ED, observation, or outpatient surgery, are considered POA.

Answer 5

True

Question 6

True or False: If final diagnosis contains a possible, probable, suspected, or rule-out diagnosis, clinical findings suspected at the time of inpatient admission, assign Y

Answer 6

True

Question 7

True or False: If a patient is admitted for an HIV related condition, the PDX is B20

Answer 7

True

Question 8

True or False: If patient with HIV is admitted for unrelated condition, the code for the unrelated condition should be the PDX.

Answer 8

True

Question 9

A late effect or sequela of a condition is defined as a condition that:
a. Remains or develops after conclusion of the acute phase of an illness or injury

b. Develops within a year of the original condition

Answer 9

A

Question 10

True or False: The purpose of a concurrent query is to eliminate retrospective queries by billing staff

Answer 10

True

Question 11

Four primary metrics to measure CDI program success:

Answer 11

• CDI staff productivity
• Actual documentation improvement that results in improved hospital profiles and 3) physician profiles
• Accurate hospital reimbursement

Question 12

Which indicator is not usually included when reporting physician profiles?
- length of stay
- individualized CMI
- ROM
- Dollars charged per hour