CPHQ Concepts Flashcards
Duties Board of Directors
setting policy; quality of care; financial & strategic direction; goals & objectives
Pt Experience Mechanisms
HCAHPS Hospital Consumer Assessment of Healthcare Providers & Systems; CAHPS Consumer Assessment of Healthcare Providers & Systems; VoC Voice of the Customer; HHC CAHPS; ED CAHPS, HAHPS Home & Community Based Services; hospital CAHPS
Hoshin Planning
strategy implementation through department deployment; develops plan with targets & means with ongoing data0based review
Balanced Scorecard components
Financial; Customer; Business Process; Learning & Growth
Managed Care Reimbursement
3rd party payers manage cost of healthcare & episodes of care
DRG
Diagnosis-Related Group; developed in US in 1980s, set pricing for specific types/buckets of care
PPOs
Preferred Provider Organizations; don’t require PCP referral for additional care
HMOs
Health Maintenance Organization; usually require PCP, narrow network
2017 Quality Payment Program
Established MIPS Merit-Based Incentive Payment System
EPO
Exclusive Provider Organization; only the network is covered
Kirpatrick Model of Evaluation
Preferred by CMS; reaction (satisfaction w/ training); learning; behavior changes; results; return on investment
Magnet Recognition
Nursing designation for quality patient care/excellence in RN practice; 5 components: innovation/improvement, transformational leadership, structural empowerment, exemplary professional practice, empirical quality results
Baldridge
Presidential Award; organizational assessment tools, used for internal PI even if not applying; 7 categories: leadership, strategy, customers, measurement, analysis & improve of organizational performance, workforce, work processes, results
Patient-Centered Medical Home
Approach to improve quality, decrease cost for primary care; team-based & focused on care coordination
NCQA Pt-Centered Connected Care
Built from medical home model of care; encourages outpatient treatment to communicate with PCP
National Quality Award Program
Recognizes long-term care; bronze, silver, or gold
Voluntary Quality Ratings
National Quality Forum; National Association Healthcare Quality; Agency for Healthcare Research; Leapfrog; Institute for Healthcare Improvement; World Health Organization; Health & Medicine Division of Institute of Medicine
Regulatory Ratings
OSHA Occupational Safety & Health Admin (US Dept of Labor); HIPAA Health Insurance Portability & Accountability Act; SNF Quality Reporting Program (for short- and long-term care, measured by hospital readmissions)
ACOs
Accountable Care Organizations; care-coordination for Medicare members
Healthcare Waste
failure of care delivery; failure care coordination; overtreatment/low value care; pricing failure; fraud & abuse; administrative complexity
CMS Quality Goals
Safe, effective, efficient, patient-centered, equitable, timely
FPPE
Focused Professional Practice Evaluation; provider competency assessment for requested privileges/care delivery; reviews pt care, medical/clinical knowledge, practice-based learning & improvement, interpersonal & communications skills, professionalism, systems-based practice
OPPE
Ongoing Professional Practice Evaluation; peer-review; confidential
How to know which events are reportable?
Follow regulatory agency
Sentinel Events
Patient safety even causing severe OR permanent harm; encouraged to report to the joint commission
MACRA Medicare Access & CHIP Reauthorization Act of 2015
Medicare physician reimbursement through MIPS or APMs
Accreditation Agencies with “deemed status” per CMS
The Joint Commission; Accreditation Commission for Health Care (ACHC) for hospitals; CIHQ Center for Improvement in Healthcare Quality (hospitals); NCQA National Committee for Quality Assurance (managed care, HEDIS); DNV GL Det Norske Veritas Germanischer Lloyd (international); Accreditation Association for Ambulatory Healthcare AAAHC; CARF International (for rehab)
Patient Safety Organizations
NPSGs National Patient Safety Goals; AHRQ Agency for Healthcare Research and Quality; not regulatory, not punitive
Human Factors Engineering
considers strengths & limitations; examines activity; focus on actual practice
Adverse Events
Due to medical care delivery, not outcome of patient condition or disease state; either preventable, ameliorable (unpreventable, but could have resulted in less harm with different care), or due to negligence
Sentinel Events
Adverse outcome; unanticipated patient safety event; JCI immediate investigation
Commission
Taking action in error
FMEA
Failure Mode & Effects Analysis; systemic, proactive approach used for new systems or system redesign; analysis completed for each failure point; prospective
RCA
Root Cause Analysis; reactive; may be regulatory requirement after sentinel event; finds basic cause and suggests corrective action after event has occurred
Corporate liability
Organization’s duty to patients
Vicarious liability
(respondent superior); employer liability for employees
Ostensible agency
liability for independent contractor clinicians
res ipsa loquitur
patient can prove clear & obvious negligence w/out establishing standard of care
Value
(quality + outcomes)/cost
Prochaska’s Stages in Changing Behavior
precontemplation; contemplation; preparation; action; maintenance; termination
Kotter’s Heart of Change Model
Not allowing complacency; communicate powerful vision; create short-term winds; anchor the change within the culture
Kotter’s 8-Stage Process for Major Change
create urgency; create guiding coalition; develop vision & strategy; communicate change vision; remove barriers to action; short-term winds; build on change; institute change
Force Field Analysis Change Model
Driving force (strengths) vs restraining force (barriers)
Diffusion of Innovation Model
knowledge, persuasion, decision, implementation, confirmation
SMART Goals
Specific, measurable, achievable, relevant, time-bound
Plan Do Check Act vs Plan Do Study Act
“study” component championed by Deming, more data-driven
The Model for Improvement
Set aims; establish measures; select changes; test via PDSA
LEAN & LEAN Sustain
system to eliminate waste and focus on customer-focused value stream through “kaizen” continuous improvement; make it mistake or error-proof “poke yoke;” safety, sort, set in order, shine, standardize, sustain
Sources of Healthcare Waste (LEAN)
TIM U WOOD Transportation, inventory excess, motion, unused creativity, waiting time, over-or incorrect processing, overproduction, defects or rework
Six Sigma
stats-based to eliminate variation; DeMAIC Define Measure Analyze Improve Control; also uses SIPOC Supplier Input Process Outputs Customer
Fishbone/Ishikawa
cause & effect brainstorming tool to ID root causes (manpower, methods, machines, materials) (people, procedure, place of work, provisions, patron)
Nominal Group Technique & multi-voting
For new groups or controversial decisions as anonymous; write ideas on card, give point value, and tally; multi-voting- doing this more and more times to find selection
RASCI Chart
Responsible, Accountable/approve (only 1!), Supportive, Consulted, Informed
Spaghetti Diagram
Layout diagram; shows flow of process in space to ID movement
Tree Diagram
paths/tasks process; multilayer with cause and effect across layers
Decision Support System
Data to guide medical management, performance evaluation, resource allocation, strategic planning & marketing
Probability Sample & Non-Probability Sample
probability sampling CAN generalize findings; non-probability sample can NOT
Snowball Sampling
Uses (participants’) network
Purposive of judgement sampling
Cohort sample
Ratio vs Interval Data
Ratio data has true 0 and no negative values; interval data is continuous and does not have true zero
Run Chart
Charts a process over time; has median line in center; 4rules to identify changes: shift rule (6+ consecutive points above or below median & don’t count value on median), trend rule (5 consecutive points going up or down; if 2 points are the same, count as single point) and runs rule (count # times line crosses median and add 1, compare to table) and astronomical point (outlier); up to 12 data points
Shewart Control Chart
To determine if process is stable; to determine special or common cause variation; has mean as central line and 3 SD upper & lower control limits; need 12+ data points and can recalculate upper & lower limits after 20-30 data points
Pareto chart
bar chart; 20%/80%
Histogram
Frequency bar plot; need 50 data points; check central location, spread, and shape (“skewed to the tail side”)
Scatter Diagram
Shows relationship between two variables
Common cause variateion
indicates stable process; variation due to system/process design
special cause variation
variation in process due to special causes that are not part of process; not stable process; ID via 1. single point outside limits; 2. shift above/below center line of 8+ points; 3. trend 6 or more points all heading up or down; 4. 2 of 3 consecutive points in outer 3rd of limits or beyond; 5. 15+ points within center line and first SD
Reliability by equivalence
0.70 okay, but 0.80 better
T-test
tests if 2 groups are different
Regression analysis
Tests if variables are correlated (-1,0 (no correlation, 1)
Chi Square
most common in healthcare lit; tests categorial or count data to see if related; p less than 0.05 means statistically significant
Confidence interval
How closely the population is related to the sample
Patient Centered Medical Home
Centered around primary care
