Chapter 19 Healthcare Improvement in the Community exam questions and answers.

1. Which of the following best describes one of the main problems in ensuring quality for health care in the United States? A. Consumers believe American health care is high-quality and the best in the world. B. Every hospital and health care agency has its own approach to data collection and documentation. C. Finances are the basis of clinical decisions, not quality of care. D. We all agree on what quality is but not on how best to measure it. ANS: B Every hospital and health care agency has its own approach to data collection and documentation. Very little is known about quality of care in this country because a variety of definitions of quality are used and it is difficult to get comparable data from health care providers and agencies. Based on international comparisons, health care in the United States does not have the best statistics related to outcomes. DIF: Cognitive Level: Understand (Comprehension) REF: p. 289 2. A wealthy factory owner says, "I don't care about the poor. I just want the best care available for me and my family. Why should I care whether other people get health care or not?" Which of the following would be the most appropriate response by the nurse? A. "If your employees are ill, who will do the work in your factory?" B. "You might catch a contagious disease from one of your employees." C. "You have a moral obligation to help those less fortunate." D. "Your personal insurance and tax costs will go up if your employees have to use community resources when they're ill." ANS: D "Your personal insurance and tax costs will go up if your employees have to use community resources when they're ill." Because the speaker's primary concern is apparently money, an appropriate response must show that the factory owner will lose money if he doesn't support the health of others in the community. DIF: Cognitive Level: Apply (Application) REF: p. 289 3. Which of the following information can be gathered by reviewing a community health report card? A. Utilization of health care services in the community B. Demographic information of the community C. Leading causes of morbidity in a community D. Frequency of malpractice claims within a community ANS: C Leading causes of morbidity in a community The term community health report card refers to different types of reports, community health profiles, needs assessments, scorecards, quality of life indicators, health status reports, and progress reports. Community health report cards can be a useful tool in efforts to help identify areas where change is needed, to set priorities for action, and to track changes in population health over time. The report card may be used to track leading causes of morbidity and mortality in a community, looking at trends over time to see if public health interventions have improved health care outcomes. DIF: Cognitive Level: Understand (Comprehension) REF: p. 289 4. Which of the following led to the development of the National Health Quality Improvement Act? A. A very famous movie and television star died as the result of a medical error. B. The number of malpractice claims had increased. C. Media such as films highlighted the reality of current medical care. D. Publicity about a few unfortunate cases caused consumers to become concerned. ANS: B The number of malpractice claims had increased. In response to a growing number of malpractice claims in the United States, the National Health Quality Improvement Act of 1986 was established, which encouraged consumers to become informed about their practitioner's practice record and created a national clearinghouse of information on provider malpractice records. DIF: Cognitive Level: Remember (Knowledge) REF: p. 290 5. Which of the following describes the principal problem with early efforts at ensuring quality of care? A. No one knows how to measure quality care. B. Professionals resisted and sabotaged such efforts. C. Standards emphasized structure, not process. D. There were no standards as to what represented quality care. ANS: C Standards emphasized structure, not process. Early efforts such as the National Health Quality Improvement Act of 1986 emphasized structure rather than process or outcome of care; hence, they did not really address the root issues of quality. DIF: Cognitive Level: Understand (Comprehension) REF: p. 290 6. An agency has not created a continuous quality improvement program. Which of the following actions should the agency take to help ensure quality care within the institution? A. Ensure appropriate policies and procedures are followed. B. Employ highly recommended and credentialed professionals to give care. C. Use administrative action to ensure that quality care is given to clients. D. Write quality care plans for the most typical problems of clients. ANS: A Ensure appropriate policies and procedures are followed. Quality assurance/quality improvement (QA/QI) programs remain the enforcers of standards of care for many agencies that have not elected to engage in a program of CQI. These activities are called assurance activities because they make certain that those policies and procedures are followed so that appropriate quality services are delivered. DIF: Cognitive Level: Analyze (Analysis) REF: pp. 290-291 7. A home care nurse is encouraging the administration of the agency to increase their quality assurance efforts. Which of the following best describes a negative outcome from this activity? A. An agency deficiency may become visible. B. An individual may be found at fault and then become fearful of being involved. C. Some agency processes may be questioned. D. Employees at the agency will have to commit extra time to complete this process. ANS: B An individual may be found at fault and then become fearful of being involved. Total quality management/continuous quality improvement are concepts that give direction for managing a system of care, whereas quality assurance focuses on the care a client receives within the system. QA is concerned with the accountability of the provider. A major problem with quality assurance efforts, done by the quality assurance team, is that individuals may be found to be at fault and hence may be fearful of reporting problems or errors. Continuous quality improvement focuses on processes and possible deficiencies of the organization as a whole so that everyone is involved. DIF: Cognitive Level: Apply (Application) REF: pp. 291-292 8. How does continuous quality improvement (CQI) differ from quality assurance? A. Quality assurance focuses on client care, whereas CQI focuses on system issues. B. Quality assurance focuses on system issues, whereas CQI focuses on individual client care. C. Quality assurance measures care at one point in time, whereas CQI is an ongoing issue. D. Quality assurance focuses on families, whereas CQI focuses on agency issues. ANS: A Quality assurance focuses on client care, whereas CQI focuses on system issues. Total quality management and continuous quality improvement are concepts that give direction for managing a system of care, whereas quality assurance focuses on the care a client receives within the system. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 292, 301 9. Which of the following is accomplished through the use of traditional quality assurance? A. Implementation of new techniques to improve outcomes B. Implementation of appropriate interventions for diagnosed problems C. Implementation of change when measured performance does not meet standards D. Implementation of research findings to ensure appropriate clinical treatment ANS: C Implementation of change when measured performance does not meet standards Traditional approaches to quality assurance are to focus on assessing or measuring performance, to ensure that performance conforms to standards, and to take action to bring about change when care does not meet standards. DIF: Cognitive Level: Understand (Comprehension) REF: p. 292 10. What is the primary goal of total quality management? A. To confirm the high standards desired in patient care B. To discover and correct errors in task completion C. To eliminate problems before negative outcomes occur D. To enable organizations to publicize their quality approach to patient care ANS: C To eliminate problems before negative outcomes occur The goal of TQM and CQI is to eliminate errors in the work process before negative outcomes occur rather than waiting until after the fact to correct individual performance; the focus is on problem prevention and continuous improvement. DIF: Cognitive Level: Understand (Comprehension) REF: p. 303 11. An agency is beginning to implement a general approach for quality improvement. Which of the following activities would the agency most likely implement? A. Customer satisfaction is assessed through the use of surveys provided to the client after each appointment. B. The health maintenance organization (HMO) provides incentives to personnel who complete in-house programs on customer service. C. The institution has received accreditation through The Joint Commission. D. The total quality improvement (TQI) team meets to examine how to make the registration process more efficient. ANS: C The institution has received accreditation through The Joint Commission. General approaches to quality improvement seek to protect the public by ensuring a level of competency among health care professionals. Examples are credentialing, licensure, accreditation, certification, charter, recognition, and academic degrees. DIF: Cognitive Level: Apply (Application) REF: p. 292