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HE210 Final Exam Questions and 100% correct Answers Latest Update
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HE210 Final Exam Questions and 100% correctAnswers Latest Update
PATEINT SAFETY - ANSWER Another dimension of health care quality is patient safety.
The patient safety movement of the 1990s spawned a lot of interest in improving health
care delivery quality through the application of methods borrowed from other industries
and pioneered by W. Edwards Deming. Deming was an American statistician,
considered the father of the modern quality assurance movement. He had developed his
system following the end of World War II. Unable to get a hearing in this country, he
went to Japan. His methods, designated Statistical Process Control (SPC) and Total
Quality Management (TQM), strongly influenced the rebirth and eventual massive
expansion of Japanese industry post- World War II. The Institute of Medicine defined
patient safety as "freedom from accidental injury; ensuring patient safety involves the
establishment of operational systems and processes that minimize the likelihood of
errors and maximizes the likelihood of intercepting them when they occur" _. It
therefore encompasses all those events and situations leading to the accidental harm of
patients, such as medication errors, surgical mistakes, falls, improper use of medical
devices, and nosocomial infection. To a large extent, the Institute of Medicine report To
Err is Human, 2000, has played a major role in bringing this issue before national
attention. The Report transformed an issue of slowly emerging professional
consciousness over a long period of time into one of significant public concern in a way
and at a speed that was, at the time, unparalleled in modern experience with issues
related to the quality of care. The studies-which concluded that more than one million
injuries and nearly 100,000 deaths occur in the United States annually as a result of
mistakes in medical care-were almost a decade old. But this was new information for the
public.
ORGANIZATIONS WITH MAJOR INFLUENCE ON HEALTH CARE QUALITY - ANSWER
The following section describes the efforts of public and private organizations to
improve the quality of health care in the United States. These efforts are increasingly
collaborative. Many businesses that pay for the health care of their employees have
banded together. Public initiatives are increasingly coordinated. And, private- public
partnerships have developed. However, it is difficult to identify the most influential
organizations. Of course, The Joint Commission and the Centers for Medicare &
Medicaid Services (CMS), because of being among the largest payers of health services
in this country, are extremely influential. But private organizations and other public
agencies also have very important roles too. Whether such massive efforts bear a
positive impact on the quality of U.S. health care remains to be seen.
,THE JOINT COMMISSION AND OTHER HEALTH CARE ACCREDITING ORGANIZATIONS
- ANSWER Although private in nature, the accrediting organizations bear immense
direct and indirect influence on quality assurance and improvement in healthcare. This
is true particularly in light of the relationship that exists between the CMS certification
process and that of accreditation by a CMS-approved accrediting organization: A
healthcare organization must be certified to participate in and receive payment under
either the Medicare or Medicaid programs, due to its compliance with the Conditions of
Participation, or standards, set forth in federal regulations. This certification is based on
an unannounced survey that a state agency conducts on behalf of the Centers for
Medicare & Medicaid Services. However, if a national accrediting organization such as
The Joint Commission has and enforces standards that meet the federal Conditions of
Participation, then CMS grants the accrediting organization "deeming" authority and
"deem" each accredited health care organization as meeting the Medicare and
Medicaid certification requirements. The health care organization would have "deemed
status" and, as such, would not be subject to the Medicare survey and certification
process. American Society for Healthcare Engineering 2012, p 1 The CoPs and
Conditions for Coverage CfCs established by CMS reflect standards that CMS believes
are requisite for quality improvement and protection of health and safety of Medicare
and Medicaid beneficiaries. Through its approval process, CMS tries to ensure that the
standards of approved accrediting organizations meet or exceed the Medicare
standards set forth in the CoPs and the CfCs. According to CMS, 2012, The Joint
Commission, 2012 is the oldest and largest health care accrediting organization in the
country and accredits nearly 19,000 health care organizations throughout the United
States including general, psychiatric, children's, and rehab hospitals; critical access
hospitals; ambulatory surgery centers; laboratories; and hospices; home health, and
nursing homes.
FEDERAL AGENCIES - ANSWER The major federal government agencies responsible
for ensuring and improving the quality of health care are described in the next section.
Each of these agencies has been discussed previously in Chapters 5 and 6, but the
following discussion focuses on their role in ensuring quality and evaluating health
systems performance. Centers for Medicare & Medicaid Services. The CMS is a federal
agency within the U.S. Department of Health and Human Services. Up until the year
2001, this organization was known as the Health Care Financing Administration or
HCFA. The CMS maintains a number of offices and programs for the advancement of
quality in health care. One of the most well-known of these is the Office of Clinical
Standards and Quality, and its Quality Initiatives (QIs) and Medicare Health Outcomes
Survey (HOS). Because Medicare and Medicaid pay for so much health care in the
United States, their ability to influence quality throughout the health care system is
enormous. The Office of Clinical Standards and Quality serves as the focal point for all
quality, clinical and medical science issues and policies for CMS programs. It
coordinates quality-related activities with outside organizations.OCSQ also monitors the
,quality of Medicare and Medicaid programs and evaluates the impact of interventions.
(CMS, 2007a, p.1) The general objective of QI is to enhance services to the recipients of
Medicare and Medicaid by methods of provider accountability and public disclosure.The
QI was introduced nation-wide in 2002 with the Nursing Home QI (NHQI) and expanded
in 2003 with the Home Health QI (HHQI) and the Hospital QI (HQI). In 2004, the Physician
Focused QI that includes the Doctor's Office Quality Project was developed.In 2004, the
QI expanded to officially include kidney dialysis facilities. The End Stage Renal Disease
(ESRD) QI promotes ongoing CMS strategies to improve PUBLIC/PRIVATE
PARTNERSHIPS AND PRIVATE INITATIVES - ANSWER There are also a number of
private initiative or private- public partnerships providing health care performance
information to consumers and purchasers. Both the consumers and the purchasers of
hospital services, such as insurance companies and the Medicare program, have a vital
interest in the quality of those services. Yet until quite recently, purchasers and
consumers had extremely limited ability to assess the quality of any aspect of care from
a hospital. In response, since then, two organizations-the National Quality Forum (NQF)
and the Leapfrog Group-have attempted to address the problem by developing uniform
measures of hospital quality and spreading information on hospital performance to
purchasers and consumers. Providing consumers and payers with information about
health care quality is controversial and as yet untested in its effectiveness. National
Quality Forum.
The NQF was a non-profit organization established to improve the quality of health care
for the American people by developing consensus on national priorities and goals for
performance improvement, endorsing national consensus standards for measuring and
publicly reporting on performance and promoting the attainment of national goals
through education and outreach programs. (National Quality Forum, 2012). Formed in
1999 as a partnership among public and private interests, the NQF seeks to promote
quality health care improvement by developing the intellectual framework for nationally
standardized performance measures and quality data reporting so that individual
hospitals and health systems can be compared. The NQF promotes the adoption of
standardized measures into consumer and stakeholder use in the health care system.
However, it must be pointed out that the NQF has no power to enforce its standards,
though payers of services of hospitals, such as insuran LEGISLATIVE INITIATIVES -
ANSWER Aside from the federal, private, and private- public efforts just discussed, state
legislatures have become involved in quality health care issues. For example, many
states have enacted or have pending legislation that requires hospitals to publicly
disclose their infection rates. These initiatives are designed to support the principle that
the threat of losing patients or purchasers to competitors with apparently better
infection control performance will motivate hospitals to improve their infection control
programs. (Quoting the venerable adage, "sunlight is the best disinfectant.")
Pennsylvania and Illinois were in the vanguard. Following widely publicized investigative
series about preventable deaths from nosocomial infection in the Chicago Tribune and
the Pittsburgh Tribune-Review, Illinois and Pennsylvania enacted policies mandating
reporting of nosocomial infections to oversight agencies by hospitals and devised plans
, to make comparative data about infection rates available to the public. These states
were the first to mandate systematic active ongoing reporting of nosocomial infection
data.
The initiatives in Illinois and Pennsylvania represent a clear consumer choice model for
addressing nosocomial infections. Rather than forcing the hospitals to implement new
infection control behaviors, the bill works by publicly releasing infection rates,
proponents argue, will better enable consumers to make proper health care decisions
as well as provide a market incentive for healthcare providers to improve infection
control in their facilities. Both the Illinois legislation known as the Hospital Report Card
Act and the new reporting rules promulgated by the Pennsylvania Health Care Cost
Containment Council took effect on January 1, 2004. After the Illinois and Pennsylvania
programs went live, Mi EQUITY OF HEALTH CARE - ANSWER Equity is the second
standard against which health care systems performance is evaluated. Equity or
distributive justice entails appropriate distribution of benefits and burdens between
those with a claim to care and those in a position to pay for it-the two groups may or may
not be the same. Aday et al., 1993, p. 120. We are concerned about inequities in access
to health care as well as inequities in the quality of health care-as measured and
evaluated by standards established for structure, process, and outcomes. We use
disparities in access and quality of health care to indicate inequity. The factors that are
consistently associated with inequities in health care access and quality are
socioeconomic status (SES), race and ethnicity, and geographic location. And study
after study finds that poor access to care and poor-quality health care are more
common for people of low income, low education, and low-status occupations; members
of minority racial and ethnic groups, especially African American and Hispanic; and
individuals residing in rural areas and inner cities.
EQUITY AND THE QUALITY OF HEALTH CARE - ANSWER Is quality health care
equitably distributed in the United States? A review of disparities in quality of care
indicates it is not (Fiscella, Franks, Gold, & Clancy, 2000). For instance, lower SES is
associated with receiving fewer Papanicolaou tests, mammograms, childhood and adult
influenza immunizations, and diabetic eye exams. Lower SES is also associated with late
enrollment in prenatal care and lower quality ambulatory and hospital care. Racial and
ethnic status is linked to quality of care received. Elderly African Americans receive
fewer procedures for preventive medicine when compared with elderly Whites.
African Americans, in general, receive less intensive hospital care, and Hispanic women
receive fewer medical procedures and preventive measures as compared to Whites.
Moreover, African Americans have also been found to have higher rates of end-stage
diabetic conditions, such as amputations, suggesting poor-quality ambulatory care.
However, a recent study from the RAND Corporation suggests that the disparities in
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