ABQAURP EVALUATION TEST QUESTIONS AND
ANSWERS SURE A+
✔✔Adverse Events- stats: - ✔✔1991-in 3.7% of hospitalization
27.6% due to negligence
70.5% of adverse events gave disability of >6m,
2.6% permanent
13.6% death
✔✔Dr, Lucian Leape - ✔✔"Error in Medicine"
Promoter of pt safety
Culture change that to error is inevitable.
✔✔JC-joint commision - ✔✔1990- only accrediting body for hosp and other health care
org in US
✔✔NPSF-national pt safety foundation - ✔✔1997-indep nonprofit org to support change
in pt safety
modeled after APSF
✔✔IOM-Institute of Medicine - ✔✔1998-effforts to assess and improve the quality of
medicine
"to Err is Human: Building a safer health system" consider to be required reading
anyone interested in pt safety.
-claimed 44k-98K Americans die each year d/t error
✔✔Active Error - ✔✔whose effects are felt immediately
-sharp end
✔✔Latent error - ✔✔-lie dormant within the system, combines c other factors to breach
systems defenses.
-blunt end
-to discover and neutralize a latent error will have greater impact on pt safety
, ✔✔Swiss Cheese Model - ✔✔Certain risk that will fall through multiple defenses to
reach the pt cause harm
-minimize error, make multiple defenses make the harm potential low
✔✔John Williamson - ✔✔best means to assess quality of care is through measuarable
outcomes
✔✔Avedis Donabedian MD - ✔✔Brought modern quality assurance techniques to
modern medicine.
✔✔Medicare Prescription Drug and Improvement and Modernization Act 2003 -
✔✔Projected focused on DM and CHF, target 5% savings
Failure, no savings. Noted lack of care coordination.
✔✔Demand Mgt - ✔✔24 h hotlines and triage service
✔✔Provider Profiling - ✔✔reimbursement tied to quality targets
Profiling tools try to decrease variation by providing docs info about their performance
✔✔Profiling Uses - ✔✔Network Mgt, Quality control, Credentialing
Utilization value based
✔✔Transactional System - ✔✔Used for provider profiling, ie ICD-9
Down side: claims only used for reimbursement not quality, coding errors
✔✔HEIDS: Healthcare Effectiveness Data and Information Set - ✔✔survey used to
measure pt satisfaction and outcomes
Used for marketing and process improvement
public issues like smoking, DM, asthma, Ca
✔✔Data Sources Available for Profiling - ✔✔Administrative Date- billing, membership
mgt, pharm benefits-widespread availability
Medical Records-accurate clinical data, but high cost
Pt Derived Data-meaningful for pt outcomes, pt satisfaction (need non-responders)
✔✔MIP-Medicare Integrity Program - ✔✔established in the HIPAA*health insurance
portability and accountability act) 1996 to address fraud
The DRA (deficit reduction act) 2006 signed into law 2006 and created MIP. They
contract c private entities to provide audits, medical necc, ID fraud
✔✔CPI=center for program integrity - ✔✔2010-integrate prevention, detection, recovery
and transparency and accountability
ANSWERS SURE A+
✔✔Adverse Events- stats: - ✔✔1991-in 3.7% of hospitalization
27.6% due to negligence
70.5% of adverse events gave disability of >6m,
2.6% permanent
13.6% death
✔✔Dr, Lucian Leape - ✔✔"Error in Medicine"
Promoter of pt safety
Culture change that to error is inevitable.
✔✔JC-joint commision - ✔✔1990- only accrediting body for hosp and other health care
org in US
✔✔NPSF-national pt safety foundation - ✔✔1997-indep nonprofit org to support change
in pt safety
modeled after APSF
✔✔IOM-Institute of Medicine - ✔✔1998-effforts to assess and improve the quality of
medicine
"to Err is Human: Building a safer health system" consider to be required reading
anyone interested in pt safety.
-claimed 44k-98K Americans die each year d/t error
✔✔Active Error - ✔✔whose effects are felt immediately
-sharp end
✔✔Latent error - ✔✔-lie dormant within the system, combines c other factors to breach
systems defenses.
-blunt end
-to discover and neutralize a latent error will have greater impact on pt safety
, ✔✔Swiss Cheese Model - ✔✔Certain risk that will fall through multiple defenses to
reach the pt cause harm
-minimize error, make multiple defenses make the harm potential low
✔✔John Williamson - ✔✔best means to assess quality of care is through measuarable
outcomes
✔✔Avedis Donabedian MD - ✔✔Brought modern quality assurance techniques to
modern medicine.
✔✔Medicare Prescription Drug and Improvement and Modernization Act 2003 -
✔✔Projected focused on DM and CHF, target 5% savings
Failure, no savings. Noted lack of care coordination.
✔✔Demand Mgt - ✔✔24 h hotlines and triage service
✔✔Provider Profiling - ✔✔reimbursement tied to quality targets
Profiling tools try to decrease variation by providing docs info about their performance
✔✔Profiling Uses - ✔✔Network Mgt, Quality control, Credentialing
Utilization value based
✔✔Transactional System - ✔✔Used for provider profiling, ie ICD-9
Down side: claims only used for reimbursement not quality, coding errors
✔✔HEIDS: Healthcare Effectiveness Data and Information Set - ✔✔survey used to
measure pt satisfaction and outcomes
Used for marketing and process improvement
public issues like smoking, DM, asthma, Ca
✔✔Data Sources Available for Profiling - ✔✔Administrative Date- billing, membership
mgt, pharm benefits-widespread availability
Medical Records-accurate clinical data, but high cost
Pt Derived Data-meaningful for pt outcomes, pt satisfaction (need non-responders)
✔✔MIP-Medicare Integrity Program - ✔✔established in the HIPAA*health insurance
portability and accountability act) 1996 to address fraud
The DRA (deficit reduction act) 2006 signed into law 2006 and created MIP. They
contract c private entities to provide audits, medical necc, ID fraud
✔✔CPI=center for program integrity - ✔✔2010-integrate prevention, detection, recovery
and transparency and accountability
