CPHQ Quiz 3

Which of the following issues might be most important to a medical group or IPA negotiating contracts with health plans?

In any quality management approach, how can you best evaluate the effectiveness of action taken?

The second sponge count at the end of a hernia repair operation on an obese patient was incorrect. This was confirmed by repeat sponge counts, and the surgeon eventually located and retrieved the missing sponge. The patient’s recovery was uneventful.
The healthcare professional should

The number of productive hours worked by nursing staff with direct patient care responsibilities per patient day is a

The senior leaders of a hospital are prioritizing performance improvement initiatives for the coming year.
Which of the following tools will be most useful for this purpose?

Senior leaders of an organization can promote quality by

The main purpose of performance improvement in healthcare is to

For a patient with insulin-dependent diabetes mellitus, which of the following programs is the most appropriate to administer?

Which of the following is NOT a key concept of Total Quality Management?

Which of the following is the first step in implementing lean management effectively in a hospital?

When a healthcare quality professional plotted data on patients’ age in a frequency histogram, she found a negatively skewed distribution. Therefore,

A healthcare quality professional can best display the distribution of 48 data points on waiting times in an ambulatory care clinic using a

A hospital purchases additional malpractice insurance and general tort liability insurance prior to introducing a paediatric heart surgery program. This is an example of

A hospitalized patient died shortly after being administered with medication intended for another patient. Which of the following tools is most appropriate for facilitating root cause analysis?

From a quality perspective, which of the following is the BEST way to control costs in healthcare?

Which of the following tools is most appropriate for investigating the relationship between two characteristics?

In an improvement project to reduce the wait times in an Emergency Room, the time taken to be assessed by a physician is

On a rheumatology ward of a hospital, a nurse accidentally administered 20 mg of methotrexate to a patient instead of the prescribed 7.5mg. When interviewed later, the nurse explained that she was accustomed to administering 20 mg of methotrexate to patients on the ward and that she was extremely busy on the morning that she committed the error.
This is an example of a

The Quality Manager of a hospital is using Nelson rules to determine whether the rate of sharps injuries is out of control. After reviewing the data, she realizes that one “rule” is missing and proceeds to include it in her analysis. In doing so, she increases the risk of a

Salaries are included in the

Root cause analysis following a sentinel event will probably require a

Which of the following strategies is MOST effective in achieving widespread adoption of a new electronic medical record system?

A 45 year old patient died in the Surgical Intensive Care Unit overnight after receiving medication intended for another patient. The Crisis Management Team is most effective if it is chaired by the

As the Director of Quality, you have recommended the engagement of an external healthcare quality consultant to fill some gaps in knowledge and time.
In selecting an external consultant, which of the following has the LEAST impact on your decision?

In data collection, Qualitative Data are to Quantitative Data as

The perception of quality by a patient receiving care in an ambulatory healthcare centre is influenced most by

Sunshine Healthcare Network is trying to adapt to new contracting arrangements that will reduce applicable reimbursements by at least nine percent. In response, leaders approve a strategic initiative to redesign administrative processes, including all quality management/ improvement activities, in order to eliminate any unnecessary steps, forms, and staff responsibilities and become as efficient as possible. The philosophy that best supports this specific initiative is

The principle underlying the selection of an organization wide quality council is

Why should a UM Plan include a conflict of interest statement?

Strategic leadership is linked to success in meeting

Community case management and disease management programs make the most economic sense for which type of reimbursement?

The organization’s governing body and CEO are being urged to make a commitment to
a culture of quality. The ideal role of the healthcare quality professional is to serve as the

In the Balanced Scorecard, the Perspective that measures human, informational, and operational capital is

Based on most quality improvement standards, those responsible to prioritize data
collection to monitor organization wide performance are

. Involving all appropriate departments/services in organization wide “Strategic Quality Initiatives” is consistent with which aspect of the performance improvement function?

An 80-year old patient falls while unattended and sustains a hip fracture. The risk manager tells, the family that related surgical expenses will be covered. The quality professional investigates the reason for the fall and reviews all falls on that unit for the previous six months. Use this
information to answer questions 33 through 35: The action by the quality professional is an example of data

A month ago the Quality Professional was asked to be the project coordinator for the
development of a “Balanced Scorecard” for her organization, Friendly Mountain Healthcare
System, an integrated delivery system of three hospitals, four large medical/specialty groups,
home health agency, hospice, two long term care facilities, and freestanding behavioural health
and rehabilitation centres. The goal is rapid development and implementation in order to provide
accurate, uniform information regarding organization wide performance both internally and to
healthcare purchasers. During the past month she confirmed that there is commitment on the
part of the executive team. She has participated in strategic planning and knows that
organization challenges include improving information technology, understanding the quality of
care being provided across the continuum, maintaining financial stability (profitability), and
providing new services to meet needs identified in the cultural assessment. These challenges
have been deemed critical success factors. Use this information to answer questions 36
through 38: The Balanced Scorecard answers which questions?

Which of the following four types of processes listed that are associated with review of medication use, blood/blood product use, or operative and other procedures use (hospital or ambulatory care), which would most likely fall under the purview of utilization management?

An affinity diagram is best used when

Based on cost-benefit analysis, Comprehensive Health integrated delivery system IDS) added a home health agency, with investments in a building, staff, marketing, computer system, and other equipment and materials. You are tracking revenue and expenses. Of the following, what type of graph will tell you when you reach the break even point?

The ability to elicit lively exchange or discussion when teaching a group is an example of

The strategy for conflict resolution that emphasizes facts and finding an appropriate
alternative solution, is called

One of the rates that best screens the clinical judgment of the hospital UM reviewer is

The change that will result within the Quality Improvement Department with the
implementation of Six Sigma will likely be received best by staff if there is

The Quality Director can best minimize department staff’s concerns if the focus is on

The benefits of studying a process include all of the following EXCEPT

A point prevalence survey in 2010 showed that the overall prevalence proportion of healthcare-associated infections in a hospital system was 7.3%. In 1990, the prevalence proportion was 8.1%. A hypothesis test for the difference between the two prevalence proportions gave a P-value of 0.029.
Which of the following is the most accurate interpretation of the results?

A team in a healthcare facility is working on a project to improve access to primary care. The average length of time to the “third next available” appointment was chosen as an outcome measure. Which of the following is the most appropriate balancing measure?

In your capacity as the Director of Quality and Patient Safety at a 1600-bed tertiary referral centre, you are consulted to assist in the development of a balanced scorecard.
In selecting measures for the scorecard, the “perspectives” commonly used include all of the following EXCEPT

In your capacity as the Director of Quality at an 800-bed multidisciplinary hospital, you are consulted on how best to reduce complication rates while reducing length of stay and cutting overall costs for total hip replacement.
Provided none of the following has already been attempted, the best option is

The senior leaders of a hospital system were interested to learn whether inpatient deaths were associated with after hours admission. Therefore, a random sample of patients who had died in hospital and a representative group of patients who did not die were selected. Subsequently, the times of their hospital admission were analysed.
Which of the following measures is most appropriate to determine whether there is an association between inpatient mortality and after hours admission?

In examining the association between inpatient mortality and after hours admission, the healthcare quality professional was interested to find out whether the distance between patients’ place of residence and the hospital might be a confounding variable.
Which of the following methods can she use to determine whether the association between inpatient mortality and after hours admission was confounded?

A healthcare quality professional examined the relationship between the rate of adverse patient occurrences and duration of overall medical practice among physicians in a hospital. In the analysis, the computed value of r was 0.8139.
The healthcare quality professional concluded that there is a

Impressed by what he saw at a healthcare conference, the Chief Executive Officer decided to adopt Lean Six Sigma as the hospital’s new approach to process improvement.
If the desired results are not achieved, which of the following is the most likely reason for this?
change to support process change.

Which of the following is the most likely cause of medication errors in an acute care facility?

Common causes of process variation refer to causes of variation that

Leaders of a multi-hospital system are trying to prioritize the services to introduce in the coming year based on their impact on the community. These leaders, who work geographically apart, can arrive at a group consensus without meeting face to face by

In analysing data, the healthcare quality professional can minimize the risk of interpreting noise as if it were a signal AND minimize the risk of failing to detect a signal when it is present by using a

The odds ratio of an outcome

Updated guidelines to prevent falls in the elderly state that patients with no evidence or history of gait problems or recurrent falls do not require a fall risk assessment. In this case, asking older patients if they have fallen recently or if their gait is unsteady is a form of

Overall responsibility for an improvement project lies with the

In improvement work, a constraint is

“From a sample of 300 patients, the estimated rate of patient falls in Hospital A is 7.2 falls per 1,000 bed-days with a 95% confidence interval ranging from 6.75 to 7.65 falls per 1,000 bed-days.”
Which of the following statements about the confidence interval is correct?

In a large tertiary hospital, 10.3% of a general surgeon’s cases in the last 3 months were associated with surgical site infections. The average surgical site infection rate for the other general surgeon’s was 4.8%. Working closely with the Chief Medical Officer, the healthcare quality professional should

Compared with its previous version, the Procedure Coding System (PCS) of the tenth edition of the International Classification of Diseases (ICD) standards describes procedures in greater detail and thus improves

In developing a patient safety training program, the healthcare quality professional must first

In your capacity as Director of Quality and Patient Safety, you are asked to develop a budget for the quality management department. Because you anticipate growth of this department in the coming year, you included the cost of new furniture and equipment, estimated at $5000.
Under which type of budget would your department’s new furniture and equipment fall?

The Emergency Department of Hospital X sees an average of 200 patients per month for the management of acute chest pain. The department plans to conduct a retrospective chart review to determine the compliance with a protocol for managing chest pain. In reviewing the charts of patients seen in the department in Year 2009, an appropriate size of a randomly selected sample is

In implementing a care bundle for the management of acute myocardial infarction, the recording of the extent to which smoking cessation counselling is provided is a measure of

Which one of the following is not useful for identifying users’ computer software
needs?

The most important question to ask when choosing computer software is:

After aggregating data, it is important to summarize the information with data-displays
so that it is

After first describing the problem, the best way to look at “patterns of behaviour” over time is to
use

The best way to incorporate the concept of alignment into reengineering is to:

Of the following, the measures most indicative of the IDS’ ability to provide value to its stakeholders are

In an organization wide QI model, the person or group usually accountable for continuously assessing and improving performance at the department level is the

Sunshine Community Medical Centre had begun performing angioplasty procedures for cardiac patients in anticipation of providing cardiovascular surgery services. The administration then failed to negotiate a contract with the cardiac surgery team of physicians. The hospital and its cardiologists then negotiated an exclusive contract with another hospital in the area to refer all
cardiac patients needing angioplasty to that facility. This action constitutes

In revising the Utilization Management (UM) Plan, which of the following is most important to
consider?

A trend has developed over the past year indicating that an internal medicine physician has significant difficulty treating patients with out-of-control diabetes who are admitted for inpatient care. Peer review of cases, along with meetings with the physician, has continued for ten (10) months. Which of the following is now the best action option to correct this performance problem?

Occurrence or event reporting is an example of

Which of the following is NOT a requirement for an organization wide QM Program?

The quality professional, acting as facilitator, meets with the Respiratory Department QI
Task-Team and identifies as the team’s first clinical task:

An 80-year old patient falls while unattended and sustains a hip fracture. The risk manager tells, the family that related surgical expenses will be covered. The quality professional investigates the reason for the fall and reviews all falls on that unit for the previous six months. Use this
information to answer questions 33 through 35: The occurrence (fall) is an example of

A month ago the Quality Professional was asked to be the project coordinator for the
development of a “Balanced Scorecard” for her organization, Friendly Mountain Healthcare
System, an integrated delivery system of three hospitals, four large medical/specialty groups,
home health agency, hospice, two long term care facilities, and freestanding behavioural health
and rehabilitation centres. The goal is rapid development and implementation in order to provide
accurate, uniform information regarding organization wide performance both internally and to
healthcare purchasers. During the past month she confirmed that there is commitment on the
part of the executive team. She has participated in strategic planning and knows that
organization challenges include improving information technology, understanding the quality of
care being provided across the continuum, maintaining financial stability (profitability), and
providing new services to meet needs identified in the cultural assessment. These challenges
have been deemed critical success factors. Use this information to answer questions 36
through 38: The basis for success of the project is

Brainstorming is best used to

At the We Care Urgent Care Centre, wait times from registration to physician contact are calculated and averaged daily. The data is tracked monthly, using a run chart. Which of the following would indicate a true statistical increase in treatment delays?

It is likely that the team selected which of the following analysis tools:

Every communication carries which two messages?

Which of the following should not be part of performance appraisal?

The annual individual performance appraisal process includes all except

The senior leaders of a managed care organization have consulted a healthcare quality professional on the purchase of a clinical data management software system to support performance improvement.
Which of the following is the most important issue in identifying the system requirements?

A licensed independent practitioner with admitting privilege at a hospital must

A series of poor surgical outcomes at a small community hospital led to an investigation which eventually found that the vast majority of recent failed surgeries were conducted by only one surgeon. The “surgeon” was subsequently discovered to have forged his medical qualifications and had been impersonating a doctor for the previous 8 months. He is currently awaiting trial on charges in connection with the surgeries he performed at the hospital.
The primary role of the healthcare quality professional in this case is

Which of the following sampling methods should a healthcare quality professional use to obtain the most precise estimate of the prevalence of pressure ulcers in a 900-bed multi-disciplinary tertiary care facility?

One of the aims in the treatment of severe community-acquired pneumonia is to maintain an oxygen saturation of >94% (or 88 – 92% in patients with chronic obstructive airway disease). Ensuring adequate oxygenation for this condition is a

Clinical decision support software is an example of

The prevalence of pressure ulcers in an acute-care facility is 18.3%. The healthcare quality professional obtained information that the prevalence of pressure ulcers across 420 acute care hospitals in the state was 14.8%. For the purpose of improvement in her hospital, the latter figure (14.8%) is best regarded as

Which of the following tools is most useful in identifying ways to shorten nurses’ walking time from one activity to another in a hospital ward?

A 37 year old woman who underwent mechanical aortic valve replacement was discharged on warfarin (Coumadin). The target International Normalized Ratio (INR) was 3.0–3.5. She developed a severe pneumonia two weeks later and was readmitted to hospital, at which time her INR was found to be 8.3.
Upon receiving a report on the elevated INR, the healthcare quality professional should first

Following a serious adverse event, a hospital decided to pursue a negotiated settlement. Which of the following would most likely apply in this situation?

Which of the following is an example of a continuous variable?

Concerning control charts, each of the following statements is true EXCEPT:

A suspicious death after surgery occurred in a prestigious hospital. Initial reports suggested that post-operative nurses might have misread physician orders for intravenous fluids. Senior management had concerns about litigation and adverse publicity.
In making rapid decisions, the Chief Executive Officer of the hospital should adopt a leadership style that is

The Board and Chief Executive Officer have renewed their commitment to improving quality in Hospital X. Your primary role as the Director of Quality & Patient Safety should be

Which three elements ensure successful implementation of computerized systems for
data collection and analysis?

The Quality Management Cycle, based on Juran’s Quality Trilogy (quality planning, quality control, quality improvement)

In evaluating their system’s structure, OHS leaders must include

In statistical process control, it is important first to

In working with the hospitals and physician practice groups (medical groups and IPAs) on QM/QI redesign, one of the important tasks to accomplish first will be to

A team has been selected from all linked services in several healthcare organizations in
the We Care Health plan [MCO] network to address information management. The term that best describes such a team is

Your hospital case management program monitors length of stay (LOS) by condition. LOS for four conditions has decreased slightly each of the last six quarters. To evaluate cost and quality of care impact, you recommend which measures?

The Baldrige Health Care Criteria for Performance Excellence establish standards for

The phrase “intensive analysis,” as used in quality/performance improvement

What can the quality professional do to best facilitate “buy-in” on the part of the
Respiratory Department?

Once the Respiratory Department has gathered and aggregated their data, the Department QI Task-Team should

An 80-year old patient falls while unattended and sustains a hip fracture. The risk manager tells, the family that related surgical expenses will be covered. The quality professional investigates the reason for the fall and reviews all falls on that unit for the previous six months. Use this
information to answer questions 33 through 35: The action of the risk manager is an example of risk

A month ago the Quality Professional was asked to be the project coordinator for the
development of a “Balanced Scorecard” for her organization, Friendly Mountain Healthcare
System, an integrated delivery system of three hospitals, four large medical/specialty groups,
home health agency, hospice, two long term care facilities, and freestanding behavioural health
and rehabilitation centres. The goal is rapid development and implementation in order to provide
accurate, uniform information regarding organization wide performance both internally and to
healthcare purchasers. During the past month she confirmed that there is commitment on the
part of the executive team. She has participated in strategic planning and knows that
organization challenges include improving information technology, understanding the quality of
care being provided across the continuum, maintaining financial stability (profitability), and
providing new services to meet needs identified in the cultural assessment. These challenges
have been deemed critical success factors. Use this information to answer questions 36
through 38: Based on the critical success factors, which of the following perspectives might be considered most important in prioritizing performance measures?

Each licensed independent practitioner must complete an extensive application to be part of a medical staff, allied health panel, or other practitioner panel, depending on the organization or health plan. What is not required on the initial application?

In the community health clinic, at least four complaints have been received per month for the past four months, compared to an average of one per month for the six prior months. The average number of patients seen per month is 2000. The trigger is >0.2%. What is the appropriate response?

Sometimes, when developing indicators to measure performance, specific criteria must be written to fully define the measure. This type of criteria facilitates which step?

Based on the analysis, what conclusion did the team report? Implementation of CTM

During the QM/UM Committee meeting of the Atlantic Medical Group, one physician takes the opportunity to express hostility over the contract health plan’s performance measures and practice guidelines, an issue not on this month’s agenda nor pertinent to the meeting topics. The Committee Chair defers the complaint to the quality professional, whose best response is to

What is probably the most effective way to secure confidentiality among QM staff?

The first round of training should rightfully include at least the

Which of the following is most effective in communicating instructions to patients before their discharge from hospital?

Among the following factors, competency assessment of staff is LEAST influenced by data related to

Which of the following graphs is most appropriate in displaying the root causes of adverse events that have occurred in a hospital system over the past 10 years?

In participative management,

The Process Management area of the Baldrige Health Care Criteria for Performance Excellence addresses each of the following EXCEPT

In team decision making, consensus means

Cross-sectional studies
questionnaire survey.

Concerning the surgical “time-out”, which of the following statements is FALSE?

The Chief Executive Officer of an acute care facility wishes to know the difference between Total Quality Management (TQM) and Six Sigma.
The healthcare quality professional should inform him that

The dimension of quality/performance that is addressed by introducing a rapid response team in a hospital is

In strategic planning, critical success factors

Which of the following are measures of dispersion?

Which of the following bodies is ultimately responsible for credentialing in a hospital?

In a facility which allows verbal/telephone orders, a nurse is asked to take a telephone order for the sedative medication Zoplicone to help a patient with insomnia. The nurse should

A patient with no prior history of major medical problems was admitted for an elective cholecystectomy. On the second postoperative day, the patient started to experience pain at the operative site and high fevers. Blood cultures were positive for Escherichia coli and other investigations confirmed the presence of a surgical site infection. The patient died of overwhelming septicaemia in the Intensive Care Unit 7 days after his operation.
From a quality standpoint, this case is best classified as a

“Epidemiological Theory” in data collection and analysis means the relationship
between