Study Session Reviews Flashcards

1
Q

What are the Level of Care and Care Settings? ie - Acute Care, Subacute Care

A

*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

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2
Q

What is The Newest Vital Sign (NVS) as a health literacy assessment tool?

A

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.

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3
Q

What is the difference between a Confused-Appropriate Response, a Localized Response, and a Purposeful-Appropriate Response?

A

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

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4
Q

What are SMART goals?

A

Specific
Measurable
Attainable/Achievable
Relative/Relevant
Time Bound

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5
Q

What is the difference between retrospective, concurrent, and prospective?

A

Concurrent: now
Prospective: future
Retrospective: past

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6
Q

What is the difference between hard savings and soft savings?

A

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.

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7
Q

What is benchmarking?

A

Comparing care between places. Assesses how an entity performs against its peers.

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8
Q

What is the difference between systemic and non-systemic quality indicators?

A

systemic: evidence-based
non-systemic: anecdotal/can be combined (evidence + opinion + experience)

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9
Q

What is the Delphi Technique?

A

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.

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10
Q

What are the two methods of Non-Systemic quality information collection?

A

Benchmarking
Delphi-Technique

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11
Q

What are The Big 3 quality improvement techniques?

A

PDSA
Six Sigma
LEAN

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12
Q

What does PDSA stand for? And what does it do?

A

Plan, Do, Study, Act

Quick and easiest option.

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13
Q

What is Six Sigma?

A

Focuses on patient safety by eliminating defects (gaps) in products, processes, or practice (rx errors, assignment errors).

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14
Q

What are the 5 steps in Six Sigma (DMAIC)?

A

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

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15
Q

What is LEAN?

A

Drive out waste.

Emphasizes reducing waste to increase value

Focuses on the stakeholders perspective of what is valuable.

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16
Q

What do you get when you combine LEAN and Six Sigma and what does it mean?

A

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

17
Q

What are some examples of what the Commission on Accreditation of Rehabilitation Facilities (CARF) accredits?

A

Medical Rehabilitation
Durable Medical Equipment (DME)
Aging services
Behavioral Health

continuous improvement services that center on enhancing the lives of persons served.

18
Q

What are some examples of what the Utilization Review Accreditation Commission (URAC) accredits?

A

Case management
Community Pharmacy
Disease management

19
Q

What are some examples of what the National Committee for Quality Assurance (NCQA) accredits?

A

Healthcare Organizations
Managed card organizations
HEIDS

20
Q

What does HEDIS stand for and what does it do?

A

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.

20
Q

What are some examples of what the joint Commission accredits?

A

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.

21
Q

What is a kaizen event?

A

When you combine LEAN and Six Sigma

22
Q

What does NQF stand for and what do they do?

A

National Quality Forum

not-for-profit, nonpartisan, membership-based organization whose mission is to improve quality of healthcare

23
Q

What is a QIO? What is a QIN? What are the the 3 major areas that the QIO-QIN focuses on?

A

Quality Improvement Organization

Quality Improvement Network

  1. Improving population health
  2. Improving quality within the healthcare system
  3. Reducing cost of care
24
Q

What is the Beneficiary and Family Centered Care QIO (BFCC-QIO)?

A

Review patient records and recommend areas of improvement. Deal with beneficiary complaints, including Medicare discharge appeals.

25
Q

What is the difference between validity and reliability?

A

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

26
Q

What form of coverage does not have a waiting period?

short term disability
long term disability
social security
workers compensation

A

Workers compensation

27
Q

What is the PHQ-2 used for?

A

Screening for Depression

28
Q

What is the PHQ-9 used for?

A

Screening, diagnosing, monitoring and measuring the severity of depression

29
Q

What is a viatical settlement?

A

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.

30
Q

What is precertification for insurance?

A

Pre-Authorization to determine if they will cover a prescribed procedure, service, or medication.

31
Q

What are the steps in the case management process?

A

Screening
Assessing
Stratifying Risk
Planning
Implementing
Follow Up
Transitioning
Communicating
Evaluating

SASPIFTCE
Sally and Sue Plan In Full Time Continuing Education

32
Q

What is an accelerated death benefit?

A

Viatical settlement - when someone sells their live insurance policy to a third party for a cash benefit to utilize while still alive

33
Q
A