Quality Improvement and Compliance Flashcards

A root cause analysis (RCA) is BEST described as:

Answer: A systematic process to identify underlying causes of adverse events

RCA is a structured method used to identify the fundamental causes of problems or adverse events in healthcare.

Under HIPAA, a covered entity must provide patients with access to their health records within how many days of a request?

Answer: 30 days

HIPAA requires covered entities to provide access to records within 30 days, with a possible one-time 30-day extension.

Which quality improvement model uses Plan-Do-Study-Act cycles?

Answer: PDSA/PDCA model

The PDSA (Plan-Do-Study-Act) cycle is a continuous improvement framework widely used in healthcare quality initiatives.

Which agency is responsible for enforcing OSHA regulations in healthcare workplaces?

Answer: OSHA (Occupational Safety and Health Administration)

OSHA is the federal agency that enforces workplace safety regulations, including those applicable to healthcare settings.

A 'never event' in healthcare refers to:

Answer: A serious, largely preventable patient safety event that should never occur

Never events are serious, preventable adverse events whose occurrence signals a fundamental failure in patient safety.

Which of the following is a primary goal of utilization management in healthcare?

Answer: Ensuring services are medically necessary and provided at the appropriate level of care

Utilization management ensures that healthcare services are medically appropriate, necessary, and delivered in the most cost-effective setting.

The Donabedian model for evaluating healthcare quality focuses on three components. Which answer correctly identifies all three?

Answer: Structure, Process, Outcome

Avedis Donabedian's model evaluates quality through Structure (resources/environment), Process (care delivery), and Outcome (patient results).