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Chapter 15. Quality of Care

Compliance with evidence-based recommendations for venous thromboembolism prophylaxis in the intensive care unit is an example of a quality measure most connected with which of the IOM domains of quality?

A. Effective

B. Patient centered

C. Equitable

D. Efficient

The proportion of patients with low back pain who had magnetic resonance imaging without trying recommended treatments first, such as physical therapy, is an example of which type of measure within Donabedian’s framework for measuring quality of care?

A. Structure

B. Efficiency

C. Process

D. Effective

The proportion of people who report being uninsured all year, by English proficiency and place of birth, is an example of a quality measure most connected with which of the IOM domains of quality?

A. Equitable

B. Patient centered

C. Access to care

D. Safety

A safety net hospital has a higher unadjusted 30-day readmission rate for heart failure than the private hospital in an affluent neighborhood across town despite showing better performance on the public-reported recommended processes of care for heart failure. The safety net hospital has a high volume of indigent patients, but the private hospital’s patients typically have higher education levels, fewer comorbidities, and better access to care. A possible explanation for the unadjusted 30-day readmission result is

A. surveillance bias.

B. reporting bias.

C. information bias.

D. confounding bias.

In 1998, Hospital A, a large academic teaching hospital, had a 2.5% operative mortality rate among patients undergoing CABG. In 1999, Hospital A partnered with local cardiac and vascular surgeons to open a neighboring specialty heart and vascular hospital, equipped to perform percutaneous coronary intervention (PCI) but not open heart surgery. From then on, the vast majority of patients with single- or two-vessel disease underwent revascularization via PCI at the specialty hospital, and patients with multivessel disease or other factors making their condition more complex continued to be treated via CABG at Hospital A. In 1999 and 2000, Hospital A saw a sharp increase in its operative mortality rate. By focusing quality improvement efforts on surgical technique and postsurgical care, ...

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