ABFM Quality Assurance and Improvement 2 — Questions and Answers
Question 1: A family medicine practice wants to reduce diabetic patient HbA1c values above 9%. Which QI model is most appropriate for rapid, iterative testing of interventions?
- Six Sigma DMAIC
- Plan-Do-Study-Act (PDSA) cycle (Correct answer)
- Lean value stream mapping
- Root cause analysis fishbone diagram
Correct answer: Plan-Do-Study-Act (PDSA) cycle
The PDSA cycle is designed for rapid, small-scale iterative testing and learning, making it the standard model for QI in clinical settings.
Question 2: Which statistical tool is most useful for determining whether variation in a process is due to common cause or special cause?
- Pareto chart
- Control chart (run chart with control limits) (Correct answer)
- Histogram
- Scatter diagram
Correct answer: Control chart (run chart with control limits)
Control charts distinguish common cause (random) variation from special cause (assignable) variation using statistically derived control limits.
Question 3: A practice is analyzing why patients miss follow-up appointments. Staff use a structured diagram to categorize causes into manpower, methods, materials, and environment. What tool are they using?
- Affinity diagram
- Cause-and-effect (Ishikawa/fishbone) diagram (Correct answer)
- FMEA matrix
- Process flowchart
Correct answer: Cause-and-effect (Ishikawa/fishbone) diagram
The Ishikawa (fishbone or cause-and-effect) diagram organizes potential causes of a problem into standard categories for systematic analysis.
Question 4: In healthcare quality improvement, what does 'reliability' most accurately refer to?
- The accuracy of a diagnostic test compared to a gold standard
- The consistent execution of evidence-based care every time it is indicated (Correct answer)
- Patient satisfaction scores above the 90th percentile
- The absence of adverse events over a defined time period
Correct answer: The consistent execution of evidence-based care every time it is indicated
Reliability in QI refers to the consistent delivery of evidence-based interventions to all eligible patients every time, often measured in defects per opportunity.
Question 5: A physician wants to improve colorectal cancer screening rates. The first step of the Model for Improvement asks which foundational question?
- How will we know a change is an improvement?
- What change can we make that will result in improvement?
- What are we trying to accomplish? (Correct answer)
- How will we measure the cost of the intervention?
Correct answer: What are we trying to accomplish?
The Model for Improvement's first question is 'What are we trying to accomplish?' which defines the aim of the QI project.
Question 6: Which measure type tracks whether a QI intervention itself causes unintended harm or negative consequences?
- Outcome measure
- Process measure
- Balancing measure (Correct answer)
- Structure measure
Correct answer: Balancing measure
Balancing measures assess whether changes made to improve one part of a system negatively affect other parts.
Question 7: A Lean QI approach in a primary care office focuses primarily on eliminating which of the following?
- Statistical variation in patient outcomes
- Waste and non-value-added steps in care delivery (Correct answer)
- Defects at the Six Sigma level (3.4 per million opportunities)
- Near-miss events identified through incident reporting
Correct answer: Waste and non-value-added steps in care delivery
Lean methodology focuses on identifying and eliminating waste (muda) and non-value-added activities to improve flow and efficiency.
ABFM Quality Assurance and Improvement 2
A family medicine practice wants to reduce diabetic patient HbA1c values above 9%.
Which QI model is most appropriate for rapid, iterative testing of interventions?