Miscellaneous Flashcards
Plan-Do-Check-Act (PDCA) describes which one of the following?
(check one)
- The accreditation process to become a patient-centered medical home
- One of the National Quality Forum’s Safe Practices for Better Healthcare
- The cycle of continuous quality improvement
- Donabedian categories of quality measurement
- The Chronic Care Model
The cycle of continuous quality improvement
Improving quality and efficiency in medicine is best done using a systems approach. One of the tools for improving a system of care is to utilize the “Plan-Do-Check-Act” cycle of continuous quality improvement. This cycle includes a planning stage to identify an improvement strategy. An implementation stage is followed by a time of evaluation for effectiveness. Finally, a decision is made to adopt or abandon the initial strategy. The cycle is then repeated as many times as necessary to attain the desired results.
The National Weight Control Registry includes individuals who have lost substantial weight without surgery, and have maintained the weight loss for an average of 5 years. Which one of the following behaviors is typical of these individuals? (check one)
Eating breakfast every day
Taking daily vitamin and mineral supplements
Weighing themselves daily
Being physically active >2 hours a day
Eating a low-protein diet
Eating breakfast every day
Individuals on the National Weight Control Registry typically eat a low-fat diet rich in complex carbohydrates, eat breakfast daily, weigh themselves at least once a week, and are physically active for 60–90 minutes a day.
You are providing medical care during a national emergency crisis and are tasked with triaging and allocating limited critical care resources when demand is greater than supply. Which one of the following processes is consistent with ethically sound crisis standards of care? (check one)
Making triage decisions based on social and community value
Explaining triage decision practices and providing a process for appealing decisions
Allocating limited resources on a first-come, first-served basis when unable to distinguish medical need among patients
Continuing a patient’s treatment without reassessment once resources have been allocated
Explaining triage decision practices and providing a process for appealing decisions
The American Medical Association Code of Medical Ethics offers helpful guidance for making difficult decisions, including triage and reassessment decisions, when health care resources are limited during crisis situations. Explaining triage decision policies and procedures and providing patients who are denied initial resources a process for appealing decisions is a recommended process and the most ethically sound option of those listed. It is also recommended to make triage decisions based on medical need rather than social worth, and to allocate limited resources first to prevent premature death and then to those with the greatest duration of benefit after recovery. When unable to distinguish need based on medical factors, a random process or lottery is recommended rather than a first-come, first-served process since patients with obstacles to care who cannot present first would be unfairly disadvantaged. Reassessment of whether continued treatment is likely to be beneficial should occur periodically. Providing palliative care when treatment has been withdrawn is a necessary ethical practice.
According to the Joint Commission’s sentinel event program, the most common root cause of serious medical errors is a deficiency of (check one)
competency and credentialing
staffing
communication
leadership
organization culture
communication
According to The Joint Commission’s sentinel event program, communication problems are the most common root cause of serious medical errors. Strategies such as the implementation of structured and standardized handoffs are an example of improving communication among members of the health care team, thereby helping to reduce errors.
Which one of the following is one of the five basic principles of the patient-centered medical home? (check one)
Utilizing the latest research and advances in treatment and diagnosis
Coordinating a patient’s care across all elements of the health care system
Acting as a gatekeeper to limit access to specialist care
Serving as the base of a pyramid in support of a complex health care system
Transitioning away from delivering care in an office, and focusing on meeting patients in their own homes
Coordinating a patient’s care across all elements of the health care system
The concept of a medical home was first suggested by the American Academy of Pediatrics in 1967 to describe the ideal care of children with disabilities. In 2004 the Future of Family Medicine Project adapted this concept to describe how primary care should be based on “continuous, relationship-centered, whole-system, comprehensive care for communities.” In 2007 all of the major primary care organizations collaborated to define the foundational principles of the patient-centered medical home (PCMH). These principles include the following:
Comprehensiveness: Most preventive, acute, and chronic care for individual patients can be performed
at the PCMH. Patient Centered: The PCMH provides care that is relationship-based, with an orientation toward the whole
person. Coordination: The PCMH coordinates care for patients across all elements of the health care system. Accessibility: The PCMH works to provide patients with timely access to providers. Quality: The PCMH continuously works to improve care quality and safety.
In 2009, the Centers for Medicare & Medicaid Services introduced the concept of Accountable Care Organizations primarily to accomplish which one of the following objectives?
(check one)
Prevent rates of reimbursement from growing faster than GDP
Increase reimbursement to medically disadvantaged regions of the United States
Require uninsured individuals to purchase health insurance at fair-market prices
Deliver more efficient, high-quality services by encouraging cooperation between health care providers
Reduce the power of integrated health systems to behave as monopolies
Deliver more efficient, high-quality services by encouraging cooperation between health care providers
The concept of Accountable Care Organizations (ACOs) was introduced in 2009 by the Centers for Medicare and Medicaid Services (CMS) to encourage doctors, hospitals, and other health care providers to work together to deliver high-quality care and spend health care dollars more wisely. The ACO concept, together with a shared savings program, has had difficulty penetrating smaller practices and more rural regions of the country. There is also concern that ACOs may allow larger systems to work as a monopoly as an unintended consequence. For this reason the Department of Justice and the Federal Trade Commission are monitoring these organizations as they develop.
This new strategy of shared savings through coordinated health care is an alternative to the Sustainable Growth Rate (SGR) formula that CMS had previously hoped would contain health-care costs. The SGR was created to prevent Medicare rates from growing faster than the GDP. The high-profile topic of requiring individuals to carry health insurance has also been part of governmental reform initiatives but is not directly related to ACOs.
You have just finished giving a prescription with instructions to a 28-year-old male from El Salvador who speaks limited English. You gave the instructions with the aid of an interpreter, but are concerned that the patient might not fully understand them.
Which one of the following is the best course of action?
(check one)
Refer the patient to a website about his condition
Repeat the instructions slowly to the interpreter and ask him or her to speak clearly to the patient
Contact a family member who speaks English and ask him or her to repeat the instructions to the patient
Ask the patient to repeat the instructions to you in his own words
Ask the patient to repeat the instructions to you in his own words
To ensure that patients from other cultures understand instructions, it is helpful to ask them to repeat the instructions in their own words. A website would probably not be specific or culturally sensitive to the patient’s condition. The physician should speak in a normal tone to the patient, and not to the interpreter. Family members may be used as convenient translators if necessary, but to maintain confidentiality and reduce miscommunication it is best to use a trained medical interpreter.
Promoting good sleep hygiene is basic in the treatment of insomnia. Which one of the following measures will aid in promoting healthy sleep habits? (check one)
Vigorous evening exercise
Taking an enjoyable book or magazine to bed to read
Drinking a glass of wine as a sedative before retiring
Eating the heaviest meal of the day close to bedtime
Maintaining a regular sleep/wake schedule
Maintaining a regular sleep/wake schedule
Maintaining a regular sleep/wake schedule helps prevent insomnia. While a light snack before bed may be sleep inducing, heavy meals close to bedtime may be counterproductive. Alcohol should be avoided as a sedative, to prevent midsleep awakenings. Hours spent reading or watching television in bed can lead to long awakenings in the middle of the night.
Which one of the following sleep disorders is in the general class of circadian sleep disorders and may respond to bright-light therapy? (check one)
Shift-work insomnia
Alcohol-dependent sleep disorder
Inadequate sleep hygiene
Sleep-related myoclonus
Shift-work insomnia
Shift-work insomnia is the only circadian sleep disorder listed. It may respond to bright-light therapy. Alcoholism is a behavioral disorder that may respond to gradual discontinuance. Inadequate sleep hygiene (use of stimulants at night, sleeping other than at bedtime, etc.) may respond to habit changes. Sleep-related myoclonus is an intrinsic sleep disorder and can be treated with levodopa or clonazepam.
Your office staff proposes a practice improvement project to create a transgender-friendly clinical environment. Which one of the following interventions would help promote this goal? (check one)
Ensuring that intake forms and records use gender-neutral or inclusive language
Offering preventive services based on expressed gender only
Offering referral to a transgender clinic to all patients
Polling the staff to see if any of them are transgender
Ensuring that intake forms and records use gender-neutral or inclusive language
Many transgender patients report negative experiences with health care providers, which can lead to avoidance of health care interactions. It is important to create a safe and welcoming environment to establish and maintain rapport. Ensuring that intake forms and records use gender-neutral or inclusive language is one way to signal this. Preventive services should be offered based on the patient’s current anatomy, not on expressed gender. Offering a referral to a transgender clinic to all patients is not necessary. Asking staff if they are transgender is invasive and unnecessary, and they may not be willing to disclose this information.
You and your office educator are preparing printed educational materials for patients, families, and caregivers. Based on current recommendations, the educator advises that these should be written at or below what reading level? (check one)
First grade
Fifth grade
Eighth grade
Tenth grade
Fifth grade
It is recommended that all printed patient education information be written at or below a fifth- to
sixth-grade reading level. This aligns with universal health literacy precautions in which easy-to-understand
concepts and terms are used for all patients instead of focusing on those with low literacy. These literacy
precautions are recommended by professional organizations such as the American Medical Association and
the Agency for Healthcare Research and Quality.
A 75-year-old patient is admitted to the hospital. The Joint Commission National Patient Safety Goals program requires medication reconciliation for this patient both on admission and at the time of discharge.
The primary intent of this reconciliation is to detect (check one)
potentially inappropriate medication use in the elderly
high-risk medication use
medication discrepancies
polypharmacy
adverse drug effects
medication discrepancies
Maintaining and communicating accurate patient medication information is one of the goals of the Joint Commission National Patient Safety Goals program. This includes medication reconciliation, which is intended to identify and resolve discrepancies. In this process, a clinician compares the medications a patient should be using and is actually using with the new medications that are ordered. While adverse drug effects, potentially inappropriate medication use in the elderly, high-risk medication use, or polypharmacy might also occur and might be beneficial to address, these are not the primary focus of medication reconciliation.
A 45-year-old male sees you for follow-up of several chronic medical problems including hypertension, diabetes mellitus, and obesity. He is a truck driver, smokes one pack of cigarettes per day, and does not exercise. His blood pressure is 166/94 mm Hg and his hemoglobin A1c is 9.7%. His medical conditions have been difficult to control with medications and he has been resistant to making lifestyle changes.
Which one of the following strategies would be most effective for inducing significant behavioral change? (check one)
Counsel the patient on the complications of smoking and uncontrolled diabetes
Utilize motivational interviewing to explore the patient’s level of desire to change
Treat the patient with an SSRI and refer him to a counselor
Transfer the patient to another family physician in your community
Utilize motivational interviewing to explore the patient’s level of desire to change
Patients who are resistant to change require skillful management. Motivational interviewing is a technique that has been shown to improve the therapeutic physician-patient alliance and help to engage patients in their own care. The other options listed are not helpful and may damage the therapeutic relationship.
The fee-for-service system of medical payments establishes a reimbursement for individual care episodes provided by physicians and hospitals. Which one of the following is the term for when this reimbursement is adjusted up or down based on quality and/or efficiency measures? (check one)
Modified fee-for-service
Bundled payments
Flexible payment strategies
Value-based reimbursement
Accountable Care Organizations
Value-based reimbursement
Value is often defined as quality divided by cost. As such, the value that a health care system provides increases as the quality of that care increases, the costs of the care decrease, or both. Value-based reimbursement is a system of health care reimbursement that seeks to motivate health care systems and/or providers to increase the value of their services rather than just seeking to increase the quantity of their services. An example of this type of payment incentive is the Center for Medicare and Medicaid Services’s move to establish a program called value-based purchasing. This program increases reimbursement rates for high-value hospitals and decreases reimbursement rates for hospitals that provide lower-value services.
Which one of the following strategies has been shown to improve the therapeutic alliance with the patient and can aid in the management of difficult patient encounters? (check one)
Ignoring and putting aside the clinician’s negative feelings about the encounter
Motivational interviewing to explore the patient’s desire, ability, reason, and need to make a change
Setting a very limited amount of time for challenging appointments to keep from interfering with the rest of the clinician’s schedule
Explaining why the patient’s findings from an online search of symptoms is inaccurate and irrelevant
Motivational interviewing to explore the patient’s desire, ability, reason, and need to make a change
Difficult patient encounters involve many factors including both patient and clinician characteristics, behaviors, feelings, and attitudes. Motivational interviewing has been shown to improve the therapeutic alliance and result in positive behavior change. Clinicians may need to adjust schedules to allow appropriate time with such patients, but judgmental or dismissive remarks are not productive.
