High-Quality Health Care Test Bank Chapter 12

Jonas & Kovner’s Health Care Delivery in the United States, 12^th Edition

Test Bank

Chapter 12, High-Quality Health Care

MULTIPLE CHOICE

1. Which of the following has helped link payment for health care services to results?

A. Passage of the Affordable Care Act (ACA)

B. Some states’ refusal of federal funds to expand Medicaid

C. New definitions of quality as it applies to health care

D. The plethora of online information about provider performance

1. Which country has often ranked last in an ongoing Commonwealth Fund study of health care in 11 countries?

A. Germany

B. Sweden

C. Australia

D. The United States

1. Which of the following is the third-leading cause of hospital deaths in the United States?

A. Cancer

B. Heart disease

C. Medical errors

D. Accidents

1. A particularly vulnerable moment for many patients occurs when which of the following occurs?

A. Discharge from the hospital

B. First consultation with a new care provider

C. Awakening in the recovery room

D. Post-surgical checkup

1. Which of the following is used by the Centers for Medicare & Medicaid Services as a quality metric?

A. Number of hospital-acquired infections

B. Readmission rates

C. Number of vaccinated children in schools

D. Patient satisfaction with providers

MULTIPLE RESPONSE

1. Which of the following are dimensions of quality according to the Institute of Medicine? Select all that apply.

A. Safety

B. Effectiveness

C. Efficiency

D. Low cost

E. Equitable access

1. Which of the following helped increase life expectancy in the United States by as much as 30 years over the course of the twentieth century? Select all that apply.

A. Dramatic reductions in cardiovascular disease

B. The transformation of HIV infection to a manageable chronic condition

C. The growing concentration of medical professionals in urban areas

D. Significant reductions in the number of people who smoke

1. Which of the following are the dimensions of quality care in the model proposed by Donabedian? Select all that apply.

A. Structures

B. Process

C. Outcomes

D. Payment

1. Which of the following ideally characterize data that can contribute to quality improvement? Select all that apply.

A. Readily available as a by-product of the care process itself

B. Accessible to all stakeholders in the health care system

C. Recent enough to permit analysis and improvement in close to real time

D. Detailed enough to enable hypothesizing about which factors contribute to current levels of quality

1. Which of the following are among the drivers that can influence provider behavior and improve quality? Select all that apply.

A. Professionalism

B. Public reporting

C. Patient privacy policies

D. National and regional quality improvement initiatives

E. Consumerism

1. Which of the following are future challenges for public reporting in the health care industry? Select all that apply.

A. The need to link cost information to quality

B. The need to incorporate social media to reach more consumers

C. The need to reduce the cost of reporting

D. The need to increase the timeliness and clinical robustness of public reports

1. Which of the following must administrators do in the years ahead to implement change in the health care industry? Select all that apply.

A. Outsource the task of improving quality and safety

B. Promote excellence in response to individual patient needs and preferences

C. Promote effective teamwork

D. Celebrate innovations that make the right thing to do the easy thing to do

MULTIPLE CHOICE

1. All medical professionals are required to do which of the following?

A. Adopt the team-based model of care

B. Develop a patient database

C. Document their commitment to continuing medical education

D. Expand their professional networks

1. Which of the following face reporting mandates in only 8 states?

A. Physicians

B. Hospitals

C. Nursing homes

D. Health plans

1. A study of public reporting in the health care industry found that about what percent of even the best reports needed substantial improvement and redesign?

A. 15%

B. 30%

C. 50%

D. 80%

1. The effort to create deliberate, targeted incentives to improve quality in health care often relies on which of the following strategies?

A. Capitation

B. Pay for performance

C. Fee for service

D. Third-party billing

1. The National Strategy for Quality Improvement was mandated by which of the following?

A. The Affordable Care Act (ACA)

B. The Centers for Disease Control and Prevention (CDC)

C. The Institute for Healthcare Improvement

D. The Partnership for Patients

1. Which of the following is a major goal of patient groups like the National Breast Cancer Coalition and the Arthritis Foundation?

A. To integrate patients’ self-reported and clinical data

B. To advocate for additional research on quality

C. To assign patient-safety letter grades to hospitals

D. To move health care payment from volume-based to value-based

1. Which of the following is a disadvantage of social media such as Facebook, Yelp, and Twitter as tools of consumer engagement in the health care industry?

A. Consumer engagement via social media is far-reaching in terms of audience and impact

B. Social media generate greater information sharing and dialogue

C. Social media offer an avenue for the patient’s voice to contribute to efforts to improve health care delivery

D. There is no credible third-party mediator in social media

1. Despite being one step removed from the actual delivery of services, an increasing number of health care payers have begun to do which of the following?

A. Encourage patients to choose ambulatory services rather than hospitalization

B. Incorporate rates of hospital-acquired infections in their payment strategies

C. Rely on social media to inform patients about quality criteria in health care

D. Look for blockbuster drugs to improve more outcomes

SHORT ANSWER

1. Identify several critical steps providers and administrators can take to improve health care quality in the United States.
2. Use an example to briefly illustrate the way the three dimensions of Donabedian’s model of quality can apply in a hospital setting. Then identify some limitations of the model.
3. Briefly describe a patient’s encounter with the health care system using the analogy of concentric circles.
4. Briefly discuss developments that are helping better align the incentives of patients, consumers, and providers to improve quality and outcomes.
5. Outline the Lean process for improving quality.

(1) Specify value from the standpoint of the end customer by product family.

(2) Identify all the steps in the value stream for each product family, eliminating wherever possible those steps that do not create value.

(3) Make the value-creating steps occur in tight sequence so the product will flow smoothly toward the customer.

(4) As flow is introduced, customers pull value from the next upstream activity.

(5) As value is specified, value streams are identified, wasted steps are removed, and flow and pull are introduced, begin the process again and continue it until a state of perfection is reached in which perfect value is created with no waste.

ESSAY

1. Describe the five C’s essential to prioritizing quality and safety within a given health care organization.

(1) Culture—is the organization one in which employees feel supported in speaking up if they see something that might lead to potential patient harm? Does the health care organization promote continuous learning and improvement?

(2) Capacity—does the organization have the right mix of clinicians, providers, and specialties?

(3) Capability—do clinicians have the right tools (data) to do their jobs?

(4) Consistency—does the organization promote the use of evidence-based research and best practices to ensure consistency in care?

(5) Candor—do providers encourage patients to ask questions about their care and work to promote a truly interactive doctor-patient dialogue? Does the organization promote transparency and access to information?

1. Explain the value of public reports comparing the quality, and sometimes the cost, of individual facilities or providers.

(1) Public reports theoretically enable consumers to comparison-shop for health care—just as they do for other products—selecting those with higher quality and/or lower costs (among other reasons, such as convenience). At the very least, an effective public report could help an individual consumer identify a hospital, physician practice, or nursing home with higher quality and/or better value. If enough informed consumers make these choices, the theory goes, the cumulative effect of individual informed decisions could improve quality across the community, with high-quality providers gaining more business and low-quality providers losing business.

(2) Employers, health plans, and others who contract with providers of care can favor high-scoring organizations when creating networks of care, and they can educate their employees or plan members about the quality differences.

(3) Public reports enable health care providers to compare their performance with that of their peers. For reasons both professional and business-related, providers do not want to be perceived poorly.

1. Identify some of the reasons that public reports about providers have not been found to significantly change consumer behavior.