AHIC Quality Improvement 3 — Questions and Answers
Question 1: Which concept in Lean methodology refers to any activity that consumes resources but does not add value from the patient's perspective?
- Kaizen
- Muda (Correct answer)
- Kanban
- Poka-yoke
Correct answer: Muda
Muda is the Japanese term for waste in Lean methodology, referring to activities that consume time, resources, or space without adding value for the customer or patient.
Question 2: A clinical informatics team is evaluating the effectiveness of a new EHR-based medication reconciliation alert. Which metric would BEST measure the alert's clinical impact?
- Alert firing rate per 1,000 orders
- Percentage of alerts acknowledged within 60 seconds
- Rate of medication discrepancy resolution following alert (Correct answer)
- Number of alert suppression requests submitted by clinicians
Correct answer: Rate of medication discrepancy resolution following alert
Measuring the rate of medication discrepancy resolution directly assesses whether the alert is achieving its intended clinical outcome of improving medication safety.
Question 3: The Donabedian model of healthcare quality assessment evaluates quality across three domains. Which correctly identifies all three?
- Input, process, output
- Structure, process, outcome (Correct answer)
- Safety, effectiveness, efficiency
- Access, timeliness, quality
Correct answer: Structure, process, outcome
Avedis Donabedian's model assesses healthcare quality through Structure (resources and settings), Process (care delivery activities), and Outcome (results of care on patient health).
Question 4: In QI methodology, what distinguishes a 'special cause' variation from a 'common cause' variation?
- Special cause variation is predictable and inherent to the system, while common cause is unpredictable
- Common cause variation is inherent to the system, while special cause arises from specific identifiable factors (Correct answer)
- Special cause variation always results in patient harm, while common cause does not
- Common cause variation can be eliminated through staff retraining alone
Correct answer: Common cause variation is inherent to the system, while special cause arises from specific identifiable factors
Common cause variation is the routine, expected variation inherent to a stable process, while special cause variation results from specific, identifiable factors outside the normal process.
Question 5: Which AHRQ tool uses hospital administrative data to screen for adverse events and measure patient safety at the population level?
- Global Trigger Tool (GTT)
- Patient Safety Indicators (PSIs) (Correct answer)
- Leapfrog Hospital Survey
- Magnet Recognition Program
Correct answer: Patient Safety Indicators (PSIs)
AHRQ's Patient Safety Indicators (PSIs) are a set of measures that use hospital inpatient administrative data to provide information on potentially preventable complications and adverse events.
Question 6: A hospital's QI dashboard shows sepsis bundle compliance has been consistently above 95% for six months. The QI team should NEXT:
- Increase the compliance target to 99%
- Shift focus to sustaining performance and monitoring for decline (Correct answer)
- Discontinue measurement since the goal is achieved
- Investigate why 5% remain non-compliant using FMEA
Correct answer: Shift focus to sustaining performance and monitoring for decline
Once a QI goal is achieved and sustained, the team should transition to monitoring and maintaining performance gains while potentially spreading the intervention elsewhere.
Question 7: Which quality improvement framework is specifically designed for use in ambulatory care settings and uses five key change concepts including 'the care team' and 'the patient'?
- IHI Breakthrough Series Collaborative
- Patient-Centered Medical Home (PCMH) model
- Wagner Chronic Care Model (Correct answer)
- NCQA HEDIS reporting
Correct answer: Wagner Chronic Care Model
The Wagner Chronic Care Model provides a framework for improving chronic illness management in ambulatory care through six interconnected elements, with the patient and care team as central components.
AHIC Quality Improvement 3
Which concept in Lean methodology refers to any activity that consumes resources but does not add value from the patient's perspective?