PHA 6081 - Quality Assurance & Improvement

quality

increases positive outcomes, corresponds with current medical knowledge to meet patient-centered wants and needs

Donabedian model

measures quality based on structure, process, and outcomes (economical, clinical, and humanistic)

structure

raw materials needed for production

process

method or procedure used

outcomes

the end result

true

T/F: today's focus on measuring quality is on outcomes

economic outcomes

direct and indirect costs and consequences that can be both medical and non-medical

condition, procedure, patient care issue

clinical outcomes may be ________ specific, _______ specific, or address ________

false

T/F: clinical outcomes are easy to measure since they occur immediately after the treatment or intervention

humanistic outcomes

measure the human aspect of care and account for the effect of a treatment on other aspects of a patient's life in conjunction with therapeutic effect or discrete health outcome

true

T/F: healthcare typically lags behind other industries in quality improvement

SEIPS model

expands the Donabedian's process concept from direct patient care to other support processes; applies systems, human factors, and quality engineering approaches

systems theory

used in medicine to improve efficiency and quality and based on Human Factors Principles that focuses on relationships between quality problems and systems in which they occur

define, examine, consider, implement, and adjust

list the five steps of systems theory

human factors principle

a systems view of quality improvement that focuses on relationships between quality problems and the system they occur in

human factors engineering

focuses on how systems work in actual practice with human beings at the control, and attempts to optimize designs to ensure safety and minimize risk of error

quality control (qc)

activity of checking goods as they are produced to detect defection and problems are addressed after they occur

false

T/F: quality control detects defects with problems before they actually occur

true

T/F: quality assurance does not consider cost when focusing on delivering the highest quality products and services

quality assurance (qa)

program for systematic monitoring and evaluation of various aspects of a project, service, or facility to ensure quality standards are being met

measured, analyzed, improved, and controlled

quality improvement processes have characteristics that can be ______, _______, _____, and _______

continuous quality improvement (cqi)

continual improvement of processes associated with providing a good or service that meets or exceeds customer expectations

CQI

QA + QI =

true

T/F: cqi is the framework used to improve patient care by looking at processes that can be measured, analyzed, improved, and controlled

Plan Do Study Act (Deming)

Lean Six Sigma

focuses on the elimination of waste and removal of variability in a process

value and quality

Lean focuses on increased _____ to the customer while Six Sigma focuses on increased _____ to the customer

failure mode and effects analysis (fmea)

prospective analysis that identifies areas for QI before they become problematic

root cause analysis (RCA)

retrospective analysis used to identify the exact cause of a problem, including how to prevent recurrence and other contributing factors

true

T/F: diversity promotes effective team function with higher variability in ideas, creativity, and innovation

true

T/F: CQI can be voluntary or mandated, with companies implementing compliance standards or QI activities as part of accreditation, registration, licensing, and certification processes

Department of Health (DOH) and Board of Pharmacy (BOP)

two entities that require QI and other improvement plans as part of standard practices that affect pharmacy

The Joint Commission (TJC)

voluntary participation however many view as mandatory as it can impact organizations' prestige and reimbursement status regarding QI and compliance

National Committee for QA (NCQA)

independent, non-profit organization that performs quality care reviews with standardized quality measurements; reviews and accredits broad range of health care programs

Health Plan Employer Data and Information Set (HEIDS)

tool used to measure performance developed by NCQA and is used by more than 90% of US health plans to measure performance over 6 domains

Leapfrog group

a nonprofit organization that conducts free, annual surveys of hospitals and ambulatory care centers on a voluntary basis; measurements included in the survey align with TJC, CMS, and the Centers for Disease Control and Prevention (CDC)

Pharmacy Quality Alliance (PQA)

national, non-profit quality organization dedicated to improving medication safety, adherence, and appropriate use; used by CMS Part D star ratings program

Agency for Healthcare Research and Quality (AHRQ)

develops the knowledge, tools, and data needed to improve the healthcare system and help consumers, healthcare professionals, and policymakers make informed health decisions