Study Session Reviews Flashcards
What are the Level of Care and Care Settings? ie - Acute Care, Subacute Care
*Acute: most intensive following brief but severe episode
*Long-Term Acute Care (Hospital): focus on more than 25 days of care (rehab, pain management, head trauma)
*Subacute care: outside of hospital (IV therapy, wound care, OT/PT)
*Inpatient rehabilitation: in hospital (patient must be able to tolerate a minimum of 3hrs of therapy per day for 5-7 days per week (post stroke, motor vehicle crash)
*Skilled Nursing Facility: 24hr skilled nursing and personal care
*Intermediate care: Patient may need nursing supervision, but does not need skilled nursing care.
*Home health care: Intermittent care in the home, must be homebound by Medicare
*Hospice: end of life
*Palliative: comforting
*Custodial care: Medical insurance doesn’t cover, assists with home personal care
What is The Newest Vital Sign (NVS) as a health literacy assessment tool?
A valid and reliable screening tool available in English and Spanish that identifies patients at risk for low health literacy. Patients are given the label and then asked 6 questions about it. Patients can and should refer to the label while answering questions.
What is the difference between a Confused-Appropriate Response, a Localized Response, and a Purposeful-Appropriate Response?
Confused Appropriate: following simple commands consistently (brushing teeth, washing hands) but unable to retain learning for new tasks
Localized: responding to stimuli, but the response is different each time
Purposeful-Appropriate: independent functioning
What are SMART goals?
Specific
Measurable
Attainable/Achievable
Relative/Relevant
Time Bound
What is the difference between retrospective, concurrent, and prospective?
Concurrent: now
Prospective: future
Retrospective: past
What is the difference between hard savings and soft savings?
Hard savings= Savings directly, quickly, and easily measurable on your profit and loss statement.
Soft savings= Possibility for future indirect improvements to your bottom line, most often due to improved efficiencies.
What is benchmarking?
Comparing care between places. Assesses how an entity performs against its peers.
What is the difference between systemic and non-systemic quality indicators?
systemic: evidence-based
non-systemic: anecdotal/can be combined (evidence + opinion + experience)
What is the Delphi Technique?
Structured process that uses a series of questionnaires, known as rounds (round robin), to gather information to work toward a mutual agreement or consensus opinion. Benefit: large numbers of professionals from different professions can be included.
What are the two methods of Non-Systemic quality information collection?
Benchmarking
Delphi-Technique
What are The Big 3 quality improvement techniques?
PDSA
Six Sigma
LEAN
What does PDSA stand for? And what does it do?
Plan, Do, Study, Act
Quick and easiest option.
What is Six Sigma?
Focuses on patient safety by eliminating defects (gaps) in products, processes, or practice (rx errors, assignment errors).
What are the 5 steps in Six Sigma (DMAIC)?
D: Define - goal and scope
M: Measure - collect data (create baseline, figure out if it needs improvement)
A: Analyze - root cause of inefficiencies, discuss potential solutions
I: Improve - develop/implement solutions
C: Control - develop metrics for assessment of change success
What is LEAN?
Drive out waste.
Emphasizes reducing waste to increase value
Focuses on the stakeholders perspective of what is valuable.
What do you get when you combine LEAN and Six Sigma and what does it mean?
Kaizen event.
Team events when a process is taken apart, process mapped, and opportunities for improvement identified as team exercise (all depts work together), allowing input from all stakeholders along the way.
short-term brainstorming session that focuses on a single challenge and improves an existing process
What are some examples of what the Commission on Accreditation of Rehabilitation Facilities (CARF) accredits?
Medical Rehabilitation
Durable Medical Equipment (DME)
Aging services
Behavioral Health
continuous improvement services that center on enhancing the lives of persons served.
What are some examples of what the Utilization Review Accreditation Commission (URAC) accredits?
Case management
Community Pharmacy
Disease management
What are some examples of what the National Committee for Quality Assurance (NCQA) accredits?
Healthcare Organizations
Managed card organizations
HEIDS
What does HEDIS stand for and what does it do?
The Healthcare Effectiveness Data and Information Set is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance.
What are some examples of what the joint Commission accredits?
The Joint Commission accredits and certifies more than 22,000 health care organizations and programs in the United States, including hospitals and health care organizations that provide ambulatory and office-based surgery, behavioral health, home health care, laboratory and nursing care center services.
What is a kaizen event?
When you combine LEAN and Six Sigma
What does NQF stand for and what do they do?
National Quality Forum
not-for-profit, nonpartisan, membership-based organization whose mission is to improve quality of healthcare
What is a QIO? What is a QIN? What are the the 3 major areas that the QIO-QIN focuses on?
Quality Improvement Organization
Quality Improvement Network
- Improving population health
- Improving quality within the healthcare system
- Reducing cost of care
What is the Beneficiary and Family Centered Care QIO (BFCC-QIO)?
Review patient records and recommend areas of improvement. Deal with beneficiary complaints, including Medicare discharge appeals.
What is the difference between validity and reliability?
Validity refers to the meaningfulness of what is being measured; is it measuring what it was intended to measure?
Reliability refers to accuracy; a CM can ensure reliability of information by avoiding bias
What form of coverage does not have a waiting period?
short term disability
long term disability
social security
workers compensation
Workers compensation
What is the PHQ-2 used for?
Screening for Depression
What is the PHQ-9 used for?
Screening, diagnosing, monitoring and measuring the severity of depression
What is a viatical settlement?
An arrangement whereby a person with a terminal illness sells their life insurance policy to a third party for less than its mature value, in order to benefit from the proceeds while alive.
What is precertification for insurance?
Pre-Authorization to determine if they will cover a prescribed procedure, service, or medication.
What are the steps in the case management process?
Screening
Assessing
Stratifying Risk
Planning
Implementing
Follow Up
Transitioning
Communicating
Evaluating
SASPIFTCE
Sally and Sue Plan In Full Time Continuing Education
What is an accelerated death benefit?
Viatical settlement - when someone sells their live insurance policy to a third party for a cash benefit to utilize while still alive
