training clinicians to effectively work in interdisciplinary teams; have an educational foundation in informatics; and deliver patient‐centered care, fully exploiting evidence‐based practice, quality improvement approaches, and informatics.
The IOM's 2004 Report on Patient Safety was the first in a series of reports published since the year 2000 to emphasize the connections among nursing, patient safety, and quality of care.
KEY TERMS
Balanced scorecards
Co‐payments
Cost shifting
Deductibles
Disease management
Gross domestic product (GDP)
Health care transparency
Outcome component of health
Outcome measurements
Primary care
Process component of health
Structure component of health
REVIEW QUESTIONS
1 The national organization that accredits health care organizations is known as which of the following?American Nurses AssociationHealth Professions CommissionAgency for Health Care Research and QualityJoint Commission
2 The largest purchaser of health care in America is which of the following?Private individualsPrivate insurance companiesHealth Maintenance OrganizationsMedicare, Medicaid, and other governmental programs
3 Who identified a structure, process, and outcome framework for quality?NightingaleDonabedianStarrLohr
4 What is the top underlying cause of health care disparity in the United States?Socioeconomic statusAgeGeographical locationChronic illness
5 Payment for health care services as a fixed dollar amount per member over a period of time is referred to as which of the following?Traditional fee for servicesProspective payment systemCapitationDiagnosis‐related groupings
6 The Patient Protection and Affordable Care Act provides comprehensive health care reform through a number of initiatives, including which of the following? Select all that apply.Restricting in‐patient hospital staysExpanding health insurance coverageTargeting fraud, abuse, and waste in health careIncreasing access to primary care servicesPromoting preventive health strategies
7 Key factors contributing to rising health care costs in the United States include which of the following? Select all that apply.An aging populationAdvancements in technologyIncreased utilization of pharmaceuticalsRising costs of primary careAdministrative costs
8 The competencies for the education of health care professionals recommended by the Institute of Medicine to improve the quality of health care include all but which of the following?Primary care settingsA patient‐centered approachUse of health information technologyEvidence‐based practice
9 The link between adverse patient outcomes and cleanliness was discovered by:W. Edwards DemingFlorence NightingaleIsabel Hampton RobbDorothea Dix
10 Three components of health care systems are:strategy, outcome, and performanceprocess, strategy, and opportunitystructure, process, and outcomeoutcome, procedure, and structure
REVIEW QUESTION ANSWERS
1 Answer: D is correct.Rationale: The national organization that accredits health care organizations is known as (D) Joint Commission. (A) The ANA is the professional nurses association. (B) Health professions Commission, and (C) the Agency for Health Care Research and Quality do not accredit health care organizations.
2 Answer D: is correct.Rationale: The largest purchaser of health care in America is (D) Medicare, Medicaid, and other governmental programs. (A) Private individuals, (B) Private insurance companies, and (C) Health Maintenance Organizations are not the largest purchaser.
3 Answer: B is correct.Rationale: (B) Donabedian identified a structure, process, and outcome framework for quality. The others, (A) Nightingale, (C) Starr, and (D) Lohr did not.
4 Answer: A is correct.Rationale: (A) Socioeconomic status is the top underlying cause of health care disparity in the United States, so (B) age, (C) geographical location, or (D) chronic illness are all incorrect.
5 Answer: A is correct.Rationale: Payment for health care services as a fixed dollar amount per member over a period of time is referred to as (A) traditional fee for services, so not (B) prospective payment system, (C) capitation, or (D) diagnostic related groupings.
6 Answer: B, C, D, E, and F are correct answers.Rationale: The Patient Protection and Affordable Care Act provides comprehensive health care reform through a number of initiatives, including all except (A) restricting in‐patient hospital stays. (B) Expanding health insurance coverage, (C) targeting fraud, abuse, and waste in health care, (D) increasing access to primary care services, and (E) promoting preventive health strategies, are all correct.
7 Answer: A, B, C, D, and E are correct answers.Rationale: Key factors contributing to rising health care costs in the United States include (A) an aging population, (B) advancements in technology, (C) increased utilization of pharmaceuticals, (D) rising costs of primary care, and (E) administrative costs.
8 Answer: A is correct.Rationale: The competencies for the education of health care professionals recommended by the Institute of Medicine to improve the quality of health care include all except (A) primary care settings. They do include (B) a patient‐centered approach, (C) use of health information technology, or (D) evidence‐based practice.
9 Answer: B is correct.Rationale: The link between adverse patient outcomes and cleanliness was discovered by (B) Florence Nightingale, not (A) W. Edwards Deming, (C) Isabel Hampton Robb, or (D) Dorthea Dix.
10 Answer: C is correct.Rational: The three components of health care systems are: (1) structure (resources or “structures” required to deliver health care), (2) process (quality activities, procedures, and tasks performed to deliver quality health care), and (3) outcome (the results of good health care delivery). Therefore (A), (B), and D are all incorrect.
REVIEW ACTIVITIES
1 Although it is difficult to modify the entire structure of health care in the U.S., what could you do to modify the process of health care delivery to improve health care quality in your organization?
2 What strategies can be used to ensure patient access to appropriate health care services in public and private health care agencies?
3 How can the five IOM health professions competencies and the need for safe, high‐quality care be achieved in health care organizations?
DISCUSSION POINTS
1 Are all adverse events inevitable?
2 How is the FDA involved in improving patient safety?
3 Do sentinel events have to be reported to TJC?
4 What are the similarities in the measures of patient safety and the measures of quality of care?
5 Should only events that harm patients be reported to external quality and safety organizations?
6 Do patients have better outcomes when they stay in the hospital longer?
7 Name three of the QSEN competencies.
8 Does blaming a nurse for an error improve patient safety?
9 Name the six aims of the health care system from the IOM Crossing the Quality Chasm 2001 report.
10 Is improving quality and patient safety expensive?