**ABQAURP QUALITY IMPROVEMENT & MANAGEMENT | LATEST CERTIFIED STUDY GUIDE WITH MOST TESTED QUESTIONS & VERIFIED ANSWERS**

ABQAURP QUALITY IMPROVEMENT & MANAGEMENT | LATEST CERTIFIED STUDY GUIDE WITH MOST TESTED QUESTIONS & VERIFIED ANSWERS Three JCAHO documents to help analysis of sentinel events: -Patient safety systems chapter -Sentinel Event Policy -RCA2 How does Failure Modes Effects Analysis (FMEA) differ from RCA? FMEA is proactive not reactive and includes identify low hanging fruit and a process to identify those variables that are far less likely (latent) but could possibly have the greatest negative effect on outcomes. TJCs Comprehensive Accreditation Manila for Hospitals (CAMH): Provides policy and guidance regarding sentinel and reviewable events between hospitals and TJC What did CMS final rule pertaining to ACA PSO provision require? Larger hospitals (50 beds) participate with a PSO or else not be allowed to contract with with health plans offered through health insurance exchanges What is Six Sigma? Quality approach that uses data-driven information to "eliminate defects", focusing not only on improvement no process flow but in reducing process variation to achieve six standard deviations between the mean and the nearest specification limit. What is LEAN Six Sigma? Consists of five basic phases: Define, Measure, Analyze, Improve, and Control (aka follow-up). DMAIC What should you think when you here terms "should, could, or would"? So what? These terms are usually indications that the process may be getting off track. These words often divert attention from the actual issues because they address expected performance rather than the reality of the situation. What was the first mainstream article arguing for a systems approach to safety? "Error in Medicine" by Lucien Leape in JAMA, December 1994 Who said "Physicians and Nurses must accept the notion that error is an inevitable accompaniment of the human condition, even among conscientious professionals with high standards. ERRORS MUST BE ACCEPTED AS EVIDENCE OF SYSTEM FLAWS NOT CHARACTER FLAWS. Until and UNLESS that happens, it is unlikely that any substantial progress will be made in reducing medical errors. Lucien Leap Utilization Review role in Quality Management Maine focus is on improving already successful care by reducing the resources used to achieve the same results Medical Records role in Quality Management They are a primary source of information. Must be understood to be either good records of good care, bad records of good care, good records of bad care, or bad records of bad care. Infection Control role in Quality Management Focus on reducing risk of Future infections What is LEAN? Approach developed in Japan focused on analysis of processes that produce outcomes and eliminating steps that do not "add value" What are the six areas of program integrity activity monitoring CMS contracts private entities to monitor? -Provider Audits -Reviewing claims for medical necessity -Identifying and investigating fraud -Ensuring that Medicare pays only for services for which it has primary responsibility -Educating providers on Medicare billing procedures -Identifying improper billing practices that affect both Medicare and Medicaid What entity did CMS create in 2010 to consolidate responsibility for administering and monitoring program integrity activities? Center for Program Integrity (CPI) What are CPI's 4 areas? -Prevention -Detection -Recovery -Transparency What is the CNC? Compromised Number Checklist: a database of Medicare beneficiary HICNs (Healthcare Insurance Claim Number) and provider ID numbers felt to be compromise What is the CTI "Four Pillar" approach? 1. Assistance with medication self-management. 2. Keeping an updated patient-centered record to facilitate information transfer between care providers.Scheduling timely follow-up appointments with primary or specialty care. 3. Understanding "red flag" events and what to do in response should one occur Medicare Part A? Pays for inpatient hospital, SNF, home health (related to a hospital stay), and hospice care - Financed by a 2.9% payroll tax split between employees and employers Medicare Part B? Pays for physician, outpatient hospital, ESRD, laboratory, DME, certain home health, and other medical services. Part B coverage is voluntary and funded 25% by premiums and 75% by general government revenues Medicare part C? Medicare advantage program. The MA plans are are generally private managed care companies that are paid by the government a capitated, monthly payment to provide all Part A and B services, and also Part D services if offered by the plan Medicare Part D? Standard prescription drug benefit. Optional, beneficiaries who choose to participate are responsible for covering a portion of the cost of their prescription drugs Medicaid? Cooperative federal-state program that provides medical care to needy individuals. To qualify for federal funds states must submit their Medicaid plan to CMS. CMS reviews to determine if plan complied with federal regulation that "assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers [to make Medicaid] care and services . . . available" 23 hour obs 2 midnight rule, the laws applications, Which report is thought to have launched the current patient safety movement? The IOM's Committee on Quality of Care in America report called 'To Err is Human: Building a Safer Health System' issued in 1999 published by the National Academies Press in 2000 Focus of voluntary reporting systems Focus on a much broader set of errors, mainly those that do no or minimal harm, and help detect system weaknesses that can be fixed before the occurrence of serious harm. How is it proposed to foster participation on voluntary reporting systems? Congress should enact laws to protect the confidentiality of certain information collected to alleviate the fears that such information may be subpoenaed and used in lawsuits. What was learned from the aviation industry? Reinforcing current approaches to training and pressuring pilots to be more careful would not improve safety. Much of aviation's safety improvement came from applying principles of social and cognitive psychology and human factors engineering to its own challenging work environment.