CCM CCM Quality Improvement & Outcomes Management 1 — Questions and Answers
Question 1: Which quality improvement model uses Plan-Do-Study-Act (PDSA) cycles to test and implement changes in care delivery?
- Six Sigma
- The Model for Improvement (Correct answer)
- LEAN methodology
- Root Cause Analysis
Correct answer: The Model for Improvement
The Model for Improvement, developed by the Institute for Healthcare Improvement (IHI), uses PDSA cycles to iteratively test and scale improvements.
Question 2: In quality management, what does the acronym HEDIS stand for?
- Health Evaluation and Data Integration System
- Healthcare Effectiveness Data and Information Set (Correct answer)
- Health Equity and Disparity Improvement Standards
- Hospital Efficiency and Diagnostic Indicator Summary
Correct answer: Healthcare Effectiveness Data and Information Set
HEDIS (Healthcare Effectiveness Data and Information Set) is a widely used set of performance measures used by health plans to assess quality of care.
Question 3: A care manager wants to reduce hospital readmission rates for heart failure patients. Which tool best helps identify the root cause of readmissions?
- Gantt chart
- Fishbone (Ishikawa) diagram (Correct answer)
- Control chart
- Scatter plot
Correct answer: Fishbone (Ishikawa) diagram
A fishbone diagram helps teams visually map and categorize potential causes of a problem to identify root causes systematically.
Question 4: Which accreditation body specifically evaluates care management programs and awards NCQA Case Management Accreditation?
- The Joint Commission (TJC)
- URAC
- NCQA (Correct answer)
- CARF International
Correct answer: NCQA
The National Committee for Quality Assurance (NCQA) offers Case Management Accreditation, assessing programs against standardized quality and performance criteria.
Question 5: What does a process measure in quality improvement assess?
- Patient clinical outcomes such as mortality rates
- Whether recommended care steps were actually performed (Correct answer)
- Financial costs of interventions
- Patient satisfaction scores
Correct answer: Whether recommended care steps were actually performed
Process measures evaluate whether specific evidence-based steps in care delivery were completed, such as whether a diabetic patient received an annual HbA1c test.
Question 6: In the context of outcomes management, which statistical tool displays variation in a process over time to distinguish normal from special cause variation?
- Pareto chart
- Histogram
- Control chart (Correct answer)
- Pie chart
Correct answer: Control chart
Control charts plot data over time with control limits to identify whether variation is due to common causes or special causes requiring intervention.
CCM CCM Quality Improvement & Outcomes Management 1
Which quality improvement model uses Plan-Do-Study-Act (PDSA) cycles to test and implement changes in care delivery?