Quality and Outcomes Measurement 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 and Outcomes Measurement flashcards as text
Which CMS program financially penalizes hospitals with excess readmissions for specific conditions?
Answer: Hospital Readmissions Reduction Program
The Hospital Readmissions Reduction Program (HRRP) reduces Medicare payments to hospitals with higher-than-expected readmission rates for targeted conditions.
In outcomes measurement, 'mortality rate' is classified as which type of outcome?
Answer: Clinical outcome measure
Mortality rate is a clinical outcome measure reflecting the end result of care delivered to a patient population.
A case manager uses a disease registry to track patients with heart failure. This tool PRIMARILY supports:
Answer: Population health management and outcomes tracking
Disease registries enable proactive population health management by tracking disease-specific patients and their clinical outcomes over time.
Which term describes the unwanted variation in clinical practice that leads to inconsistent patient outcomes?
Answer: Practice variation
Practice variation refers to differences in how providers deliver care that are not explained by patient characteristics and often lead to inconsistent outcomes.
A case manager's program shows improved medication adherence rates after implementing a telephonic follow-up protocol. This improvement is BEST measured by tracking:
Answer: Pre- and post-intervention medication possession ratio (MPR)
The medication possession ratio (MPR) is a validated metric for adherence that allows direct pre- and post-comparison of the intervention's impact.
Which Donabedian framework component is represented by the availability of a multidisciplinary team in a case management program?
Answer: Structure
Donabedian's structure component refers to the resources, settings, and organizational features that support care delivery, including staffing and team composition.
A care management organization wants to demonstrate ROI. Which metric would BEST demonstrate cost-effectiveness of its program?
Answer: Reduction in total cost of care per member per month
Reduction in total cost of care per member per month directly demonstrates financial ROI by showing that program costs are offset by reduced care expenditures.