HSCI 4300 CH 7-9 Q's
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School
California State University, Stanislaus *
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Course
4300
Subject
Health Science
Date
Feb 20, 2024
Type
Pages
6
Uploaded by ElderExploration12951
HSCI 4300 INTRODUCTION TO HEALTH CARE MANAGEMENT
Chapters 7-9 Questions
1. What are Donabedian’s three elements for defining quality in health care?
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Structure, process, and outcomes are interrelated and can be used to identify areas for
improvement in healthcare delivery. For example, if a healthcare facility has poor
outcomes, it may be necessary to examine the processes used to deliver care and the
structure of the facility to identify areas for improvement. Similarly, if a healthcare
facility has poor structure, it may be necessary to examine the processes used to deliver
care and the outcomes of care to identify areas for improvement. By using all three
components, healthcare providers and policymakers can gain a more complete
understanding of the quality of care being delivered and take steps to improve it.
2. The IOM report,
To Err is Human,
examined the high rate of medical errors in U.S. hospitals.
What were these errors due to?
-
To Err Is Human
first brought public attention to the issue of medical errors, concluding
the fact that between 44,000 and 98,000 people die every year from medical mistakes. It
also diagnosed the quality problem as not one of poorly performing people, but of people
struggling to perform within a system that is riddled with opportunities for mistakes to
happen, i.e system failures. The second IOM report,
Crossing the Quality Chasm
,
outlined a number of goals for improving the quality and performance of the U.S.
healthcare system, as well as some of the methods for achieving those goals.
3. What are the five elements of CQI?
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(1) process focus
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(2) customer focus
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(3) data-based decision making
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(4) employee empowerment
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(5) organization-wide impact.
4. What are the six principles of lean according to Toussaint and Berry?
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(1) Attitude of continuous improvement
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(2) Value creation
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(3) Unity of purpose
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(4) Respect for people who do the work
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(5) Visualization
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(6) Flexible regimentation
5. Why does the delivery of health care lend itself to automation?
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As efficiencies through automation were gained by these ancillary information systems, a
parallel maturation of medical devices, apps, and informatics tools occurred. Many of
these devices, apps, and tools are oriented to enhancing workflow through increased
throughput and reduced variation. These include advances in AI; robotic prescription
dispensing services in the pharmacy, which pick, dispense, and label medications for
delivery to patients; and analyzers in the laboratory, which afford high-speed and
consistent processing of specimens.
6. Which level of EMRAM represents an organization’s ability to electronically exchange data
with other health care organizations?
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Level 7, which is when a hospital no longer uses paper charts for patients and utilizes
data warehousing to make data ready for real time and summary analytics, meets specific
requirements for interoperability, and where physicians have very high compliance scores
for order entry and documentation.
7. The ability to get a diagnosis and be treated without a doctor’s office visit is now common
through what three technologies?
-
The ability to have a new physician evaluate your medical history without ever physically
seeing you, and the ability to diagnose and treat you without having to visit a doctor’s
office or clinic is now common through telehealth, digital health, and virtual health.
8. What does interoperability refer to?
-
This refers to the “ability of different information technology systems and software
applications to communicate, exchange data, and use the information that has been
exchanged”.
9. EMR and EHR are different. What is the focus of EHRs?
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-
EHRs focus on the total health of the patient, going beyond standard clinical data
collected in the provider’s office and inclusive of a broader view on a patient’s care. They
are also built to share information with other health care providers.
10. What does the acronym HIMSS stand for?
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Healthcare Information and Management Systems Society (HIMSS).
11. Is providing information from a patient’s medical record to pharmaceutical companies
considered a violation of HIPAA?
-
Yes, it is considered a HIPAA violation.
12. The Centers for Medicare and Medicaid anticipate that the share of the economy devoted to
health care will reach what percent by 2026?
-19.7%
13. Most insurance policies require insured individuals to bear some of the cost of care
out-of-pocket. What are deductibles?
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Deductibles are required levels of payments that the insured individual/family must meet
before the insurer begins making its payments for care in a fee-for-service plan.
14. Often an insurance policy has various types of limitations. What is a lifetime limit?
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This is the maximum amount that the policy will pay out over the lifetime of the insured
individual. This type of limit usually only comes into play when there are catastrophic
types of illnesses requiring very costly care.
15. What Medicare change in 2006 produced the largest increase in cost?
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The Prescription Drug Benefit, Medicare Part D, and/or MMA, produced the largest
additions and changes to Medicare and was projected to cost $395 billion in its first
decade alone.
16. Define what a ‘near miss’ is and give an example.
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A situation in which an error occurred but no harm was caused. For example, a high risk
patient needs to ambulate to maintain their strength while on bed rest. However, the
non-skid socks are left behind as the patient walks around the unit. A staff member
notices this right away and notifies a supervisor in order to prevent injury.
17. What does sensitivity to operations refer to?
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It is the tactical aspect of managing and maintaining constant situational awareness and
making continuous adjustments to meet fluctuating demands. This is about health care
units operating as self-organizing systems, continuously learning from the current
conditions and improvising when the need exceeds the capacity of the system to meet the
demand.
18. Define the three types of cost sharing in health insurance and give an example of each.
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1. Deductibles: required levels of payments that the insured individual/family must meet
before the insurer begins making its payments for care in a fee-for-service plan. Example:
with a $500 deductible, the person would pay the first $500 of covered services.
-
2. Copayments: costs that are borne by the insured individual at the time of service.
Example: a prescribed medication or a doctor’s office visit may require a $20 copay.
-
3. Coinsurance: under a fee-for-service policy, insured individuals pay a portion of the
cost of their care, and the insurer is responsible for the remaining costs. Example: the
insured’s coinsurance is often 20 percent and the insurer pays 80 percent.
19. Explain in your own words, what moral hazard is and why it is a concern for health care.
-
Moral hazard is a concept in which an individual is likely to opt into the use of coverage.
This is a concern for health care when an insured person spends an extra day in the
hospital or pays for a procedure that would not have been purchased otherwise.
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