Quality And Performance Improvement: Q’s And A’s
Utilization management (UM) Right Ans - 1. A collection of systems and
processes to ensure that facilities and resources, both human and
nonhuman, are used maximally and are consistent with patient care needs
2. A program that evaluates the healthcare facility's efficiency in providing
necessary care to patients in the most effective manner
Utilization Management (UM) Right Ans - is composed of a set of
processes used to determine the appropriateness of medical services
provided during specific episodes of care. Whether the services are
determined to be appropriate is based on the patient's diagnosis, the site of
care, the length of stay (LOS), and other clinical factors.
Function of the UM Right Ans - Utilization review, case management,
and discharge planning.
Utilization review (UR) Right Ans - The process of determining whether
the medical care provided to a specific patient is necessary according to
preestablished objective screening criteria at time frames specified in the
organization's utilization management plan
Utilization review (UR) Right Ans - Is the process of determining
whether care provided to a specific patient is necessary. pre-established
objective screening criteria are used as the basis of UR.
Performance improvement (PI) Right Ans - The continuous study and
adaptation of a healthcare organization's functions and processes to
increase the likelihood of achieving desired outcomes
Risk management (RM) Right Ans - A comprehensive program of
activities intended to minimize the potential for injuries to occur in a
facility and to anticipate and respond to ensuring liabilities for those
injuries that do occur. The processes in place to identify, evaluate, and
control risk, defined as the organization's risk of accidental financial
liability
Case management Right Ans - 1. A process used by a doctor, nurse, or
other health professional to manage a patient's healthcare (CMS 2013) 2.
,The ongoing, concurrent review performed by clinical professionals to
ensure the necessity and effectiveness of the clinical services being
provided to a patient
Case Management Right Ans - The prinicipal process by which
organization optimize the continuum of care for their patients
Case management Right Ans - is the ongoing review of clinical care to
ensure the necessity and effectiveness of the services being provided to the
patient.
The primary role of the case manger is to coordinate and facilitate care.
coordinate medical care and ensure the medical necessity of the services
provided to beneficiaries.
Continuum of Care Right Ans - The totality of healthcare services
provided to a patient and his or her family in all settings, from the least
extensive to the most extensive.
Case manager Right Ans - A nurse, doctor, or social worker who
arranges all services that are needed to give proper healthcare to a patient
or group of patients (CMS 2013)
basic function of the risk management are Right Ans - risk identification
and analysis
Loss prevention and reduction
claims managements
Six sigma Right Ans - Uses statistics for measuring variation in a process
with the intent of producing error free results.
quality measure are Right Ans - Acute myocardial infarction, heart
failure, pneumonia.
Quality improvement (QI) Right Ans - A set of activities that measures
the quality of a service or product through systems or process evaluation
and then implements revised processes that result in better healthcare
outcomes for patients, based on standards of care
, Continuous quality improvement (CQI) Right Ans - A team approach to
improvement that rewards the group when things get better instead of
encourage a culture of blame if things go wrong.
Quality improvement organization (QIO) Right Ans - An organization
that performs medical peer review of Medicare and Medicaid claims,
including review of validity of hospital diagnosis and procedure coding
information; completeness, adequacy, and quality of care; and
appropriateness of prospective payments for outlier cases and
nonemergent use of the emergency room. Until 2002, called peer review
organization
QIOs Right Ans - are contracted to the federal government to use
medical peer review, data analysis, and other tools to identify patterns of
care and outcomes that need improvement and then to work cooperatively
with facilities and individual physicians to improve care.
Pay for performance Right Ans - refers to initiatives and programs that
reward organizations and providers for quality outcomes
Performance improvement are based on several fundamentals principles
Right Ans - -The structure of a system determine its performance
-All system demonstrate variation
-Improvement rely on the collection and analysis of data that increase
knowledge.
-PI require the commitment and support of top administration
-PI works best when leaders and employees know and share the
organization's mission, vision, and values
-PI effort take time and require a big investment in people.
-Excellent teamwork is essential
- communication must be open, honest, and multidirectional.
- success must be celebrated to encourage more sucess.
Basic responsibilities of the quality management department are Right
Ans - 1- helping department or groups of departments with similar issues
to identify potential quality problems.
2- Assisting determination of the best methods for studying potential
problems ( for example survey, chart review, or interview with staff)
Utilization management (UM) Right Ans - 1. A collection of systems and
processes to ensure that facilities and resources, both human and
nonhuman, are used maximally and are consistent with patient care needs
2. A program that evaluates the healthcare facility's efficiency in providing
necessary care to patients in the most effective manner
Utilization Management (UM) Right Ans - is composed of a set of
processes used to determine the appropriateness of medical services
provided during specific episodes of care. Whether the services are
determined to be appropriate is based on the patient's diagnosis, the site of
care, the length of stay (LOS), and other clinical factors.
Function of the UM Right Ans - Utilization review, case management,
and discharge planning.
Utilization review (UR) Right Ans - The process of determining whether
the medical care provided to a specific patient is necessary according to
preestablished objective screening criteria at time frames specified in the
organization's utilization management plan
Utilization review (UR) Right Ans - Is the process of determining
whether care provided to a specific patient is necessary. pre-established
objective screening criteria are used as the basis of UR.
Performance improvement (PI) Right Ans - The continuous study and
adaptation of a healthcare organization's functions and processes to
increase the likelihood of achieving desired outcomes
Risk management (RM) Right Ans - A comprehensive program of
activities intended to minimize the potential for injuries to occur in a
facility and to anticipate and respond to ensuring liabilities for those
injuries that do occur. The processes in place to identify, evaluate, and
control risk, defined as the organization's risk of accidental financial
liability
Case management Right Ans - 1. A process used by a doctor, nurse, or
other health professional to manage a patient's healthcare (CMS 2013) 2.
,The ongoing, concurrent review performed by clinical professionals to
ensure the necessity and effectiveness of the clinical services being
provided to a patient
Case Management Right Ans - The prinicipal process by which
organization optimize the continuum of care for their patients
Case management Right Ans - is the ongoing review of clinical care to
ensure the necessity and effectiveness of the services being provided to the
patient.
The primary role of the case manger is to coordinate and facilitate care.
coordinate medical care and ensure the medical necessity of the services
provided to beneficiaries.
Continuum of Care Right Ans - The totality of healthcare services
provided to a patient and his or her family in all settings, from the least
extensive to the most extensive.
Case manager Right Ans - A nurse, doctor, or social worker who
arranges all services that are needed to give proper healthcare to a patient
or group of patients (CMS 2013)
basic function of the risk management are Right Ans - risk identification
and analysis
Loss prevention and reduction
claims managements
Six sigma Right Ans - Uses statistics for measuring variation in a process
with the intent of producing error free results.
quality measure are Right Ans - Acute myocardial infarction, heart
failure, pneumonia.
Quality improvement (QI) Right Ans - A set of activities that measures
the quality of a service or product through systems or process evaluation
and then implements revised processes that result in better healthcare
outcomes for patients, based on standards of care
, Continuous quality improvement (CQI) Right Ans - A team approach to
improvement that rewards the group when things get better instead of
encourage a culture of blame if things go wrong.
Quality improvement organization (QIO) Right Ans - An organization
that performs medical peer review of Medicare and Medicaid claims,
including review of validity of hospital diagnosis and procedure coding
information; completeness, adequacy, and quality of care; and
appropriateness of prospective payments for outlier cases and
nonemergent use of the emergency room. Until 2002, called peer review
organization
QIOs Right Ans - are contracted to the federal government to use
medical peer review, data analysis, and other tools to identify patterns of
care and outcomes that need improvement and then to work cooperatively
with facilities and individual physicians to improve care.
Pay for performance Right Ans - refers to initiatives and programs that
reward organizations and providers for quality outcomes
Performance improvement are based on several fundamentals principles
Right Ans - -The structure of a system determine its performance
-All system demonstrate variation
-Improvement rely on the collection and analysis of data that increase
knowledge.
-PI require the commitment and support of top administration
-PI works best when leaders and employees know and share the
organization's mission, vision, and values
-PI effort take time and require a big investment in people.
-Excellent teamwork is essential
- communication must be open, honest, and multidirectional.
- success must be celebrated to encourage more sucess.
Basic responsibilities of the quality management department are Right
Ans - 1- helping department or groups of departments with similar issues
to identify potential quality problems.
2- Assisting determination of the best methods for studying potential
problems ( for example survey, chart review, or interview with staff)
