CCM Quality Control & Process Improvement 3 — Questions and Answers
Question 1: A care management team wants to reduce avoidable ER visits by streamlining the nurse triage process. Which Lean concept involves eliminating non-value-added steps?
- Poka-yoke
- Waste reduction (Muda) (Correct answer)
- 5S methodology
- Kanban
Correct answer: Waste reduction (Muda)
Lean's concept of Muda identifies and eliminates eight types of waste that add no value to the patient or process.
Question 2: Which accreditation body sets quality and performance standards specifically for managed care organizations?
- The Joint Commission (TJC)
- NCQA (National Committee for Quality Assurance) (Correct answer)
- CARF International
- DNV GL Healthcare
Correct answer: NCQA (National Committee for Quality Assurance)
NCQA accredits health plans and managed care organizations and administers the HEDIS quality measurement set.
Question 3: HEDIS measures are primarily used to:
- Credential individual care managers
- Assess and compare health plan performance on clinical and service quality (Correct answer)
- Set Medicare reimbursement rates
- Audit hospital discharge records
Correct answer: Assess and compare health plan performance on clinical and service quality
HEDIS (Healthcare Effectiveness Data and Information Set) provides standardized measures to compare health plan quality.
Question 4: A care manager is reviewing a scatter plot showing the relationship between care management contact frequency and hospital admissions. What does a strong negative correlation indicate?
- More contacts are associated with more admissions
- More contacts are associated with fewer admissions (Correct answer)
- Contact frequency has no effect on admissions
- The data is unreliable
Correct answer: More contacts are associated with fewer admissions
A strong negative correlation means as one variable increases, the other decreases — suggesting more contacts may reduce admissions.
Question 5: Which of the following best describes a 'sentinel event' in healthcare quality management?
- A near-miss that was caught before reaching the patient
- An unexpected occurrence involving death or serious physical harm (Correct answer)
- A patient complaint filed with administration
- A routine adverse drug reaction
Correct answer: An unexpected occurrence involving death or serious physical harm
A sentinel event is an unexpected incident resulting in death or serious harm that signals the need for immediate investigation.
Question 6: In the context of quality improvement, 'reliability' of a care process refers to:
- Patient satisfaction with care coordination
- The consistency with which a process produces the intended outcome every time (Correct answer)
- Cost-effectiveness of an intervention
- Compliance with documentation standards
Correct answer: The consistency with which a process produces the intended outcome every time
Process reliability measures how consistently care steps are performed correctly across all patients and all settings.
Question 7: A case manager is asked to perform a gap analysis for a disease management program. The PRIMARY purpose of this activity is to:
- Identify patients who need immediate hospitalization
- Compare current performance to desired performance standards (Correct answer)
- Calculate cost savings from care management interventions
- Screen patients for eligibility criteria
Correct answer: Compare current performance to desired performance standards
A gap analysis identifies the difference between current state performance and the target or benchmark performance.
CCM Quality Control & Process Improvement 3
A care management team wants to reduce avoidable ER visits by streamlining the nurse triage process.
Which Lean concept involves eliminating non-value-added steps?