CHAP Quality Improvement & Risk Management Flashcards

Which federal agency maintains the National Practitioner Data Bank (NPDB) used in healthcare credentialing?

Answer: Health Resources and Services Administration (HRSA)

The NPDB is maintained by HRSA and contains reports of malpractice payments, adverse actions, and other matters affecting healthcare practitioners' credentialing.

In quality improvement, what does a 'Pareto chart' help identify?

Answer: The few causes responsible for the majority of problems

A Pareto chart uses bars and a line to display the frequency of causes in descending order, illustrating the 80/20 rule — that roughly 80% of problems stem from 20% of causes.

What is 'credentialing' in healthcare administration?

Answer: The process of verifying a practitioner's education, training, licensure, and competence before granting practice privileges

Credentialing is the formal process of verifying and assessing a healthcare practitioner's qualifications, including education, training, licensure, experience, and competency.

Which quality improvement approach focuses on reducing process variation and defects to achieve near-perfect quality using statistical methods?

Answer: Six Sigma

Six Sigma uses statistical methods (DMAIC: Define, Measure, Analyze, Improve, Control) to identify and eliminate defects, aiming for no more than 3.4 defects per million opportunities.

What is the primary function of a healthcare organization's quality committee?

Answer: To oversee quality improvement initiatives and monitor performance metrics across the organization

The quality committee provides governance oversight for quality improvement programs, reviews performance data, approves improvement initiatives, and ensures accountability for quality outcomes.

What does 'utilization management' involve in healthcare administration?

Answer: Evaluating the medical necessity and appropriateness of healthcare services to ensure efficient resource use

Utilization management (UM) reviews the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities to optimize resource use and control costs.