Quality Control & Process Improvement Flashcards
7 cards from real CCM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Quality Control & Process Improvement flashcards as text
A care management team wants to reduce avoidable ER visits by streamlining the nurse triage process. Which Lean concept involves eliminating non-value-added steps?
Answer: Waste reduction (Muda)
Lean's concept of Muda identifies and eliminates eight types of waste that add no value to the patient or process.
Which accreditation body sets quality and performance standards specifically for managed care organizations?
Answer: NCQA (National Committee for Quality Assurance)
NCQA accredits health plans and managed care organizations and administers the HEDIS quality measurement set.
HEDIS measures are primarily used to:
Answer: Assess and compare health plan performance on clinical and service quality
HEDIS (Healthcare Effectiveness Data and Information Set) provides standardized measures to compare health plan quality.
A care manager is reviewing a scatter plot showing the relationship between care management contact frequency and hospital admissions. What does a strong negative correlation indicate?
Answer: More contacts are associated with fewer admissions
A strong negative correlation means as one variable increases, the other decreases — suggesting more contacts may reduce admissions.
Which of the following best describes a 'sentinel event' in healthcare quality management?
Answer: An unexpected occurrence involving death or serious physical harm
A sentinel event is an unexpected incident resulting in death or serious harm that signals the need for immediate investigation.
In the context of quality improvement, 'reliability' of a care process refers to:
Answer: The consistency with which a process produces the intended outcome every time
Process reliability measures how consistently care steps are performed correctly across all patients and all settings.
A case manager is asked to perform a gap analysis for a disease management program. The PRIMARY purpose of this activity is to:
Answer: Compare current performance to desired performance standards
A gap analysis identifies the difference between current state performance and the target or benchmark performance.