Question 1

An important component of the informatics infrastructure is:&#10;A) establishment and adoption of standards to support semantic interoperability.&#10;B) defined standard value sets, groupings, aligners, and attributes.&#10;C) organizations enabled to set individual standards for quality measurement and reporting.&#10;D) variation in the types of data used to populate the quality metrics.

Accepted Answer

Establishment and adoption of standards at multiple levels are important components of the informatics infrastructure. The standard quality metrics must define standard value sets, taxonomies, concept codes, attributes, and data structures. Organizations must adopt the same standards for quality measurements and reporting. Standard clinical content needs to be adopted and used in the electronic systems, and the content should be represented by standard data terminologies.

Question 2

When evaluating quality and patient safety, which approach defines the framework for Patient Safety and Quality Research Design (PSQRD)?&#10;A) Outcomes are driven mainly by Meaningful Use directives.&#10;B) Consideration of current managerial processes has no effect on patient outcomes.&#10;C) Patient safety is best achieved by minimizing changes to existing processes.&#10;D) Quality and safety are based on organizational structure, management and clinical processes, and their linkages to patient outcomes.

Accepted Answer

According to Donabedian, quality is based on organizational structure, processes, and their linkages to patient outcomes. Consideration of current managerial processes in place has a latent effect on patient outcomes. The framework for PSQRD builds upon Donabedian's structure-process-outcome model to support evaluation of an intervention from the preimplementation testing phase through implementation and evaluation. In the case of a health information technology (IT) intervention, the expanded framework supports understanding where the health IT intervention is most likely to have an effect, within the organizational causal chain of quality and safety events. The PSQRD framework provides a means to categorize interventions according to areas of the causal chain targeted.

Question 3

Why is the PSQRD a useful framework for research and practice?&#10;A) It explains why using computer applications is the best way to support better patient outcomes.&#10;B) It supports implementation, performance improvement, and rigorous research methodologies.&#10;C) It ensures successful implementation of a clinical process change.&#10;D) It increases communication among clinical staff.

Accepted Answer

While the PSQRD framework may improve communication and implementation, a critical strength of this framework is its systems approach and comprehensive strategy for ongoing monitoring and evaluation. The PSQRD framework provides a means to introduce health IT interventions in a systematic way, and it serves as a reminder to incorporate measures of success across the causal chain. This approach supports implementation, performance improvement, and research projects with an appreciation for the effects and the limitations of health IT and other intervention components.

Question 4

A nurse forgets to walk a patient during the nurse's shift. This is an example of an error of:&#10;A) commission.&#10;B) omission.&#10;C) condition.&#10;D) remission.

Accepted Answer

Forgetting to do something that is required for a patient would be considered an error of omission. Doing the wrong thing would be considered an error of commission. Condition and remission are not considered error types.

Question 5

A nurse gives a patient the wrong drug. This is an example of an error of:&#10;A) commission.&#10;B) omission.&#10;C) condition.&#10;D) remission.

Accepted Answer

Doing the wrong thing would be considered an error of commission. Forgetting to do something that is required for a patient would be considered an error of omission. Condition and remission are not considered error types.

Question 6

A hospital has an integrated clinical decision support system embedded in the EHR. According to Donabedian's model, this would be considered:&#10;A) structure.&#10;B) process.&#10;C) outcome.&#10;D) effectiveness.

Accepted Answer

The setting and its attributes (eg, the physical structure of buildings, staffing rations, the equipment available within an organization, and the budget to support care provision) are all part of structure. The EHR with an embedded CDS system is part of the structure of an organization.

Question 7

A nurse uses a CDS system to make an informed clinical decision regarding a drug dosage ordered for a patient. According to Donabedian's model, this would be considered:&#10;A) structure.&#10;B) process.&#10;C) outcome.&#10;D) effectiveness.

Accepted Answer

The managerial and clinical processes in place to support the provision of care are all included under the process component. The use of a CDS system is considered process.

Question 8

A unit has been experiencing a high rate of patient falls for the past 3 months. According to Donabedian's model, patient falls would be considered:&#10;A) structure.&#10;B) process.&#10;C) outcome.&#10;D) effectiveness.

Accepted Answer

The end results of the structures and processes are considered outcomes. These may include clinical outcomes. The measurement of patient falls is considered an outcome.

Question 9

To automatically track the quality of care, standardized quality measures are needed in order to: (Select all that apply.)&#10;A) use consistent metrics.&#10;B) benchmark.&#10;C) standardize data collection.&#10;D) ensure clinical efficiency.&#10;E) have intuition.

Accepted Answer

To automatically track the quality of care, standardized quality measures are needed to ensure that all organizations are using consistent metrics for benchmarking and that organizations are using the same types of data to populate the quality metrics.

Question 10

Which items are included in the IOM six aims for improvement? (Select all that apply.)&#10;A) Safe&#10;B) Patient-centered&#10;C) Innovative&#10;D) Effective&#10;E) Unintrusive

Accepted Answer

The six aims for improvement are safe, effective, patient-centered, timely, efficient, and equitable. Innovation and level of intrusion are not among the six aims for improvement.

Deck 24: Patient Safety and Quality Initiatives in Informatics