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質問 # 378
A hospital is working to decrease the length of stay for inpatients on a surgical unit.
Which of the following should be measured to document aspects of the process that are non-value added?
正解：A
解説：
To decrease the length of stay for inpatients on a surgical unit, measuring delays between steps in the patient care process is crucial. These delays often represent non-value-added time that can be reduced or eliminated to streamline patient flow and reduce overall length of stay. Identifying and addressing these inefficiencies can lead to more timely care and quicker discharges. Number of services provided (A): This measures volume, not process efficiency.
Turnaround time for diagnostic test results (B): This is important but only one component of potential delays.
Nursing productivity (D): While important, it does not directly address process inefficiencies related to length of stay.
Reference
NAHQ Body of Knowledge: Lean Principles and Process Optimization
NAHQ CPHQ Exam Preparation Materials: Reducing Length of Stay through Process Improvement
質問 # 379
An outpatient medical clinic wants to test whether a relationship exists between two factors: lack of available transportation and the number of times patients do not keep appointments. Which of the following tools should be used?
正解：C
解説：
* A scatter diagram is a graphic representation of the relationship between two variables12. It is used to test a theory that the two variables are related and to assess the strength, trend, and shape of that relationship2.
* A Pareto chart is a type of bar chart that shows the frequency or impact of different causes or problems in descending order, along with a line graph that shows the cumulative percentage of the total3. It is used to identify the most significant factors among a large number of potential causes or problems3.
* A control chart is a type of line chart that shows how a process changes over time, with upper and lower limits that indicate the range of acceptable variation4. It is used to monitor and control a process and to detect special causes of variation that may indicate problems or improvement opportunities4.
* A histogram is a type of bar chart that shows the frequency distribution of a single variable in a data set5. It is used to summarize and display the shape and spread of the data and to identify outliers or gaps5.
* Based on these definitions, the best tool to use for the outpatient medical clinic's purpose is a scatter diagram, as it can show whether there is a relationship between lack of available transportation and the number of times patients do not keep appointments, and how strong or weak that relationship is. The other tools are not suitable for this purpose, as they do not show the relationship between two variables. References: 1: Scatter Diagram | Digital Healthcare Research 2: Scatter Plot - Clinical Excellence Commission 3: Pareto Chart | Institute for Healthcare Improvement 4: Plotting basic control charts: tutorial notes for healthcare practitioners 5: Histogram | Institute for Healthcare Improvement
質問 # 380
An organization has Implemented a quality improvement project. The goal is a mean compliance rate of 90%.
The results of observations are found in the table below:
Which focus area presents the greatest opportunity for the organization?
正解：C
質問 # 381
A strategy to address social determinants of health would be to
正解：D
解説：
A strategy to address social determinants of health involves creating patient education materials that are culturally competent. Culturally competent materials consider the cultural, linguistic, and literacy needs of the patient population, making the information accessible and relevant. This approach helps to bridge gaps in understanding and engagement, which are often influenced by social determinants such as education, income, and cultural background.
* Launch a community campaign to promote influenza vaccines (A): While important for public health, this is not directly focused on social determinants of health.
* Identify high-risk patients with high-cost medications (B): This is more related to cost management and clinical care than addressing social determinants.
* Implement a standard questionnaire for pediatric lead screening (D): This addresses a specific health issue but does not broadly address social determinants of health.
References
* NAHQ Body of Knowledge: Addressing Social Determinants of Health in Healthcare
* NAHQ CPHQ Exam Preparation Materials: Culturally Competent Care and Education
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質問 # 382
Based on the data below, which unit should the quality Improvement coordinator focus on?
正解：C
解説：
Based on the data below, which shows the percentage of patients who acquired a hospital-associated infection (HAI) in each unit, the quality improvement coordinator should focus on Unit C, which has the highest rate of HAI among the four units.
A hospital-associated infection (HAI) is an infection that patients get during or after receiving health care in a hospital or other health care facility. HAIs can cause serious complications, increase morbidity and mortality, prolong hospital stays, and increase health care costs. Therefore, preventing and reducing HAIs is a key quality and safety goal for health care organizations.
A quality improvement coordinator is a professional who develops and implements quality improvement initiatives, monitors and evaluates quality performance, and provides education and support to staff and leaders on quality methods and tools. One of their responsibilities is to identify and prioritize areas for improvement based on data analysis and evidence-based practices.
To determine which unit should be the focus of quality improvement efforts, the quality improvement coordinator can use a data analysis tool such as a Pareto chart, which shows the frequency or impact of different factors or causes in descending order, along with a cumulative line that indicates the percentage of the total. A Pareto chart can help identify the most significant issues or opportunities for improvement, based on the 80/20 rule, which states that 80% of the effects come from 20% of the causes.
Using the data below, a Pareto chart can be created as follows:
Table
Unit
HAI Rate (%)
A
5
B
7
C
12
D
4
The Pareto chart shows that Unit C has the highest HAI rate (12%), followed by Unit B (7%), Unit A (5%), and Unit D (4%). Thecumulative line shows that Unit C alone accounts for 40% of the total HAI rate, and Units C and B together account for 63.3% of the total HAI rate. Therefore, according to the Pareto principle, the quality improvement coordinator should focus on Unit C, as it represents the most significant problem area and the greatest opportunity for improvement.
The quality improvement coordinator can then conduct a root cause analysis to identify the possible factors or causes that contribute to the high HAI rate in Unit C, such as staff compliance, infection control practices, patient characteristics, environmental factors, etc. A root cause analysis can be facilitated by using a visual tool such as a fishbone diagram, which organizes possible factors into categories, such as people, process, equipment, environment, etc. The quality improvement coordinator can also collect and compare data from other units or sources to identify gaps and best practices.
Based on the root cause analysis, the quality improvement coordinator can then develop and implement an action plan to address the identified causes and improve the HAI rate in Unit C. The action plan should include specific, measurable, achievable, relevant, and time-bound (SMART) goals, interventions, and indicators. The quality improvement coordinator can also involve the staff and leaders of Unit C in the planning and implementation process, to ensure their engagement and ownership of the improvement efforts.
The quality improvement coordinator should also monitor and evaluate the progress and outcomes of the action plan, using data collection and analysis tools such as run charts, control charts, or statistical process control (SPC), which can show the variation and trends in the HAI rate over time. The quality improvement coordinator should also provide feedback and recognition to the staff and leaders of Unit C, and make adjustments to the action plan as needed, based on the data and evidence.
References:
NAHQ HQ Principles, Module 2: Data Management, Lesson 2.3: Data Analysis Tools, Topic 2.3.1: Pareto Chart, Topic 2.3.2: Fishbone Diagram NAHQ Learning Lab: The Role of the Healthcare Quality Professional in Population Health Management, Module 3: Data Collection and Analysis, Slide 16: Pareto Chart, Slide 18: Fishbone Diagram NAHQ Journal for Healthcare Quality, Volume 42, Issue 5, September/October 2020, Article: Utilization of Improvement Methodologies by Healthcare Quality Professionals During the COVID-19 Pandemic, Page
283: Figure 1. Pareto Chart of COVID-19 Cases by State as of June 30, 2020 NAHQ News and Media, News: Shaping the Future of the Healthcare Quality Profession, Paragraph 5: The Role of the Quality Improvement Coordinator NAHQ Resources, Healthcare Quality Solutions: Ready Your Workforce for Quality, Page 5: The Role of the Quality Improvement Coordinator
質問 # 383
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