Quality Improvement and Risk Management (C430) Questions And Answers
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Course
Quality Improvement and Risk Management
Institution
Quality Improvement And Risk Management
Quality Improvement and Risk Management
(C430) Questions And Answers
Property Risks Involve the possibility of losses associated with the destruction or theft of
property.
Casualty/Liability Risks Involve professional negligence, worker's comp, directory and
officers liability, environmenta...
Quality Improvement and Risk Management
(C430) Questions And Answers
Property Risks Involve the possibility of losses associated with the destruction or theft of
property.
Casualty/Liability Risks Involve professional negligence, worker's comp, directory and
officers liability, environmental liability and product liability.
Employee Benefit Risks Cost of benefit plans, disability claims, and Employee
Retirement and Income Security Act (ERISA) violations.
Risk Management Tools • Incident Reporting
• Occurrence reporting
• Occurrence screening
Incident Reporting The identification and reporting of occurrences that could have led, or
did lead, to an undesirable outcome.
Occurrence Reporting Serves as a database for further investigation
,Quality Improvement and Risk Management
(C430) Questions And Answers
Alerts risk management to a potential claim situation.
Occurrence Screening Review technique of medical records of current and discharged
patients with the goal of identifying events not consistent with routine. Used to identify and
correct problems and to prepare for legal defense.
Managing Adverse Events Requires extensive analysis and planning to arrive at the best
and fairest solution for all involved.
Information must get to the upper-level administration and to the clinical chief or chiefs ASAP.
It is also important for details of clinical incidents to be chared with clinicians throughout the org
to prevent recurrence of adverse events.
How do risk and quality management functions overlap? Quality control is doing what
you want to do: meeting needs.
Risk control is not doing what you do not want to do: preventing errors.
, Quality Improvement and Risk Management
(C430) Questions And Answers
Regulatory & Professional Organizations That Influence Quality & Risk Management •
Joint Commission
• National Committee for Quality Assurance (NCQA)
• OSHA
• ADA
• Drug-Free Workplace Act (DFWA)
• HIPAA
• EMTALA
• MedWatch
• EPA
National Committee for Quality Assurance (NCQA) Performance Measures •
Effectiveness of care
• Access/availability of care
• Utilization
• Risk adjusted utilization
• Measures collected using electronic clinical data systems
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