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CCMC > Domain 3 > Flashcards

Domain 3 Flashcards

1
Q

Quality Indicators

A

Objective and quantitative measures of the structures, processes, or outcomes of care, indicating a starting point for those who want to improve care/processes
-Clinical
-Financial
-Productivity
-Utilization
-Quality
-Client experience

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2
Q

Benchmarking

A

Comparing care between two places

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3
Q

Delphi Technique

A

Method of obtaining quality indictors through questionnaires

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4
Q

Plan-Do-Study-Act Approach (PDSA) – Quality Improvement Strategy

A

Plan- identify process that isn’t providing ideal outcomes
Do- measure key performance attributes
Study- devise new approach
Act- integrate new approach

Small scale

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5
Q

Six Sigma Approach – Quality Improvement Strategy

A

Focuses on eliminating defects (in products, processes, or practice) to improve patient safety

DMAIC
Define- goal
Measure- collect data
Analyze- reveal root cause of inefficiencies
Improve- develop and implement methods to address deficiencies
Control- assess success in implemented changes

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6
Q

Lean Approach – Quality Improvement Strategy

A

Reduce waste and increase value

Waste is identified as DOWNTIME:
Defects
Overproduction
Waiting
Non-utilized talent
Transportation
Inventory
Motion
Extra-processing

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7
Q

Kaizen – Quality Improvement Strategy

A

Lean and Six Sigma combined: continuous improvement

7 phases:
-Identify
-Analyze
-Develop solution
-Implement solution
-Study results
-Standardize solution
-Plan for future

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8
Q

Accreditation

A

Voluntary process in which trained peer reviewers evaluate a healthcare organization’s compliance with national and accreditation standards

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9
Q

Commission on Accreditation of Rehabilition Facilities (CARF) – Accreditation Agency

A

Non-profit accreditor of health and human services focused on improving service outcomes, client satisfaction, and quality service delivery

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10
Q

Utilization Review Accreditation Commission (URAC) – Accreditation Agency

A

Primary focus is case management to enable health programs to build a program capable of managing transitions

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11
Q

National Committee for Quality Assurance (NCQA) – Accreditation Agency

A

Accreditor of healthcare organizations and managed care organizations, maintains HEDIS measures, core is care coordination, patient-centeredness, and quality of care

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12
Q

Healthcare Effectiveness Data and Information Set (HEDIS)

A

Measures standardized performance measures (90) in 6 healthcare domains of care

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13
Q

The Joint Commission (TJC) – Accreditation Agency

A

Accredits variety of healthcare settings, evaluates healthcare organizations to inspire them to excel in providing safe and effective care at highest quality and value, certification programs offered for condition/disease management and Primary Care Medical Home/Integrated Care

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14
Q

National Quality Forum (NQF) – Healthcare Quality Organization

A

Non-profit, non-partisan, membership based, endorse performance measures to quantify healthcare processes, outcome, patient perceptions, and organizational structures/system, public and private sector

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15
Q

Centers for Medicare and Medicaid Services (CMS)

A

Federal agency within US Department of Health and Human Services. Contracts with agencies to manage 2-fold initative of QIOs and QIN

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16
Q

Beneficiary and Family Centered Care Quality Improvement Oganization (BFCC-QIO) – Healthcare Quality Organization

A

Works under direction of CMS, analyze data and patient records to identify areas for improvements in care for beneficiaries, address individual complaints

17
Q

Clinical Quality Measures (CQMs)

A

Track quality of healthcare services provided and examine providers’ ability to deliver high-quality care or relate to long-term goals for quality healthcare

18
Q

Quality Innovation Network-Quality Improvement Organization (QIN-QIO) – Healthcare Quality Organization

A

12 regional contractors designed to improve quality of healthcare for people with specific conditions or address specific gaps in healthcare for Medicare beneficiaries, shares resources, help healthcare entities understand different quality initiatives

19
Q

Agency for Healthcare Research and Quality (AHRQ) – Healthcare Quality Organization

A

Publishes and disseminates national clinical practice guidelines, evidence-based, maintains Healthcare Cost and Utilization Project (HCUP), 4 QI models: prevention, inpatient, patient safety, pediatric

20
Q

National Quality Strategy (NQS) – Healthcare Quality Organization

A

Led by AHRQ, 3-6-9 approach: triple aim-6 priorities of common health concerns-9 levers to align function

21
Q

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

A

Nationally standardized survey of patients’ perspectives of their hospital experience allowing objective comparison of hospitals, used to calculate VBP incentive

22
Q

Cost-Benefit Analysis Report

A

Provide a summary of case management interventions and document overall costs of care and savings related to CM activities

23
Q

Hard Savings

A

Savings directly related to case manager’s actions (i.e. decrease in length of stay, transfer)

24
Q

Soft Savings

A

Potential savings, costs avoided due to case management intervention (i.e. avoid ER visits, readmission)

25
Q

Cost-Benefit Analysis Equation

A

Cost savings = potential costs - (actual cost + cost of CM)

26
Q

Health Risk Assessment (HRA) – Risk Stratification Tool

A

Tool to assess a patient’s health status, risk of negative health outcomes, and readiness to change certain behaviors; used to design prevention plan

27
Q

Predictive Modeling – Risk Stratification Tool

A

Uses technology and statistical methods to analyze large amounts of data to predict outcomes for patients

28
Q

Adjusted Clinical Group (ACG) – Risk Stratification Tool

A

Uses diagnostic and phamaceutical code information from insurance claims and medical records to measure morbidity in large populations based on disease patterns, age, and gender

29
Q

Acuity

A

Level of need and frequency of CM intervention

30
Q

Community Assessment Risk Screen (CARS) – Risk Stratification Tool

A

Determines risk for rehospitalization and ER visits for seniors

31
Q

Hierarchical Condition Category (HCC) – Risk Stratification Tool

A

Used to calculate risk scores that quantify and project financial risk of each Medicare beneficiary to adjust payments to Medical Assistance plans

32
Q

LACE Tool – Risk Stratification Tool

A

L- length of stay
A- acuity of admission
C- comorbidities
E- ER visits

33
Q

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

A

Nursing home surveys

34
Q

Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS)

A

Home health care surveys

CCMC (5 decks)

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