[2024年12月] 最新のNAHQ CPHQ認定練習テスト問題
確認済みCPHQ問題集と解答で一年間無料最速更新
質問 # 51
Quality improvement approaches are derivatives and models of the ideas and theories developed by thought leaders
and include all of the following EXCEPT:
- A. ISO 2001
- B. Associate for process improvements
- C. PDCA/PDSA
- D. Baldrige criteria
正解：A
質問 # 52
Patient and family advisory council is one of the most effective strategies for involving families and patients in the
design of care. Council responsibilities may include input on or involvement in:
- A. Marketing plan or practice services
- B. Staff evaluation
- C. Program development, implementation, and evaluation
- D. Planning for major renovation or the design of a new building or service
正解：C、D
質問 # 53
For cheing the outcomes our focus of attention is blood pressure of patients with diabetes.
Its criteria and standard can be respectively:
- A. None of these
- B. Criterion: Percentage of patients with diabetes whose blood pressure is at or below 130/85 and Standard: At least 50% of patients with diabetes have blood pressure at or below 130/85
- C. Criterion: Sugar level in blood on daily basis and Standard: How many times sugar level rises and how many times it declines in a week
- D. Criterion: Percentage of post heart attack patients prescribed beta-bloers on discharge and Standard:
At least 96% of heart attack patients receive a beta-bloer prescription on discharge
正解：B
質問 # 54
Generally, medical record review and prospective data collection are considered the most time-intensive and expensive ways to collect information.
Many reserve these methods for highly specialized improvement projects or use them to answer questions that have:
- A. Combine code and chart based on the overall population
- B. Use rule-based software development
- C. Situation related characteristics
- D. Surfaced following review of administrative data sets
正解：D
質問 # 55
Numerous opportunities for improvement exist in every healthcare organization. However, not all improvements are of the same magnitude.
Improvements that are powerful and worthy of organization resources include those:
- A. That will positively affect a large number of patients
- B. Eliminate or reduce instability in critical clinical or business processes
- C. Increase risk
- D. Ameliorate serious problems
正解：D
質問 # 56
A healthcare organization had three medication incidents associated with narcotics. None of the events led to permanent loss of function or death, but could be considered near misses.
Which of the following would be the best tool to use to identify influencing factors?
- A. nominal group technique
- B. root cause analysis (RCA)
- C. report from electronic health record (EHR)
- D. proactive risk assessment
正解：B
解説：
In the case of three medication incidents involving narcotics that were near misses, the best tool to identify influencing factors is a Root Cause Analysis (RCA). RCA is a systematic process used to investigate and understand the underlying causes of adverse events or near misses. The goal is to identify contributing factors and underlying system issues that need to be addressed to prevent future occurrences. RCA is particularly suited for situations where an incident has already occurred and the organization needs to understand how and why it happened.
Report from electronic health record (EHR) (A): While EHR data can provide useful information, it is not a tool for identifying root causes of incidents.
Proactive risk assessment (C): This would be more appropriate before incidents occur, not after near misses.
Nominal group technique (D): This is a group decision-making process and is less suited for detailed analysis of incidents compared to RCA.
Reference
NAHQ Body of Knowledge: Root Cause Analysis in Incident Investigation
NAHQ CPHQ Exam Preparation Materials: Incident Analysis Tools
質問 # 57
In healthcare, many terms call for more precise operational definitions that how do an organization define the terms such as:
- A. A patient fall (a partial fall, a fall with injuries, or an assisted fall)
- B. Qui turnaround time
- C. Surgical end time
- D. An accurate environmental compliance
正解：A、B
質問 # 58
Physicians' actions have been noted be a major contributor to unexplained clinical variation in healthcare. Unexplained clinical variation leads to increased healthcare costs, medical errors, patient frustration, and poor clinical outcomes. The increase in information being collected on physician practice patterns has begun to expose widespread variations in practice.
In healthcare, variation exists among providers by:
- A. Specialty and practice setting
- B. Facilities
- C. Staff performance
- D. Geographical region
正解：A、D
質問 # 59
A home healthcare organization is looking to identify third-party endorsed outcome measures for the following areas:
improvement in medication management
improvement in ambulation
improvement in pain
Which organization can best provide this information?
- A. The Joint Commission (TJC)
- B. URAC
- C. National Quality Forum (NQF)
- D. Leapfrog Group
正解：C
解説：
The National Quality Forum (NQF) is the best organization to provide third-party endorsed outcome measures for areas such as improvement in medication management, ambulation, and pain. NQF is a nonprofit organization that reviews, endorses, and recommends standardized performance measures for use in healthcare quality improvement. These measures are widely recognized and used by healthcare organizations to ensure high-quality care and improve patient outcomes.
Leapfrog Group (A): Primarily focuses on hospital safety and quality reporting, but not specifically on outcome measures like those listed.
The Joint Commission (TJC) (B): Accredits and certifies healthcare organizations, focusing on overall quality standards rather than specific outcome measures.
URAC (C): Provides accreditation for various types of healthcare organizations but does not focus on endorsing specific outcome measures.
Reference
NAHQ Body of Knowledge: Quality Measurement and NQF-Endorsed Measures
NAHQ CPHQ Exam Preparation Materials: Identifying and Using Outcome Measures
質問 # 60
A multidisciplinary team has been convened to review delays in laboratory turnaround time between the medicine clinic and the laboratory. The team's first step in evaluating the issue is to
- A. create a flow chart to study the process.
- B. observe how the medical assistants prepare the specimens.
- C. conduct a failure mode and effects analysis (FMEA).
- D. see if the surgery clinic is also experiencing delays.
正解：A
解説：
The first step for a multidisciplinary team tasked with evaluating delays in laboratory turnaround time is to create a flow chart to study the process. A flow chart visually maps out the steps involved in the current process, allowing the team to understand each stage, identify bottlenecks, and pinpoint where delays might be occurring. This provides a clear, shared understanding of the process among all team members, which is essential before diving into more detailed analysis or improvements.
* Conduct a failure mode and effects analysis (FMEA) (B): FMEA is a valuable tool for identifying potential failures, but it is typically used after understanding the process in detail.
* See if the surgery clinic is also experiencing delays (C): While this could be useful information, the primary focus should be on the specific process under review.
* Observe how the medical assistants prepare the specimens (D): Observation is important, but understanding the entire process flow is the first step.
References
* NAHQ Body of Knowledge: Process Mapping and Flowcharting in Quality Improvement
* NAHQ CPHQ Exam Preparation Materials: Initial Steps in Process Improvement
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質問 # 61
Case-mix adjustment accounts for the different types of patients in institutions. Adjustment should be considered
when hospital survey results are being released to the public. The characteristics commonly associated with the
patient reports on quality of care are all of the following EXCEPT:
- A. Patient age (i.e., older patients tend to report fewer problems with care)
- B. Patient satisfaction
- C. Discharge service (e.g., childbirth patients evaluate their experiences more favourably
than do medical or surgical patients; medical patients report the most problems with care) - D. Number of visits to the hospitals
正解：B
質問 # 62
Which of the following payment systems carries the most financial risk for a provider?
- A. capitation
- B. fee for service
- C. upside-only bundles
- D. pay for performance
正解：A
解説：
* A payment system is a method of reimbursing providers for the services they deliver to patients.
* Different payment systems have different implications for the financial risk that providers face, which is the possibility of losing money or not making a profit from their activities.
* Financial risk can be influenced by factors such as the volume and mix of services, the cost and quality of care, the patient population, and the market conditions.
* Fee for service (FFS) is a payment system where providers are paid for each service they perform, regardless of the outcome or value of the service. This payment system carries the least financial risk for providers, as they can increase their revenue by increasing the quantity of services. However, this payment system may also create incentives for overutilization, inefficiency, and low quality of care.
* Capitation is a payment system where providers are paid a fixed amount per patient or per member per month, regardless of the number or type of services they provide. This payment system carries the most financial risk for providers, as they have to cover all the costs of care for their patients within the fixed budget. However, this payment system may also create incentives for efficiency, coordination, and prevention of care.
* Pay for performance (P4P) is a payment system where providers are paid based on the quality and outcomes of the care they provide, rather than the quantity or type of services. This payment system carries a moderate financial risk for providers, as they have to meet certain performance measures or benchmarks to receive the full payment or bonus. However, this payment system may also create incentives for quality improvement, patient satisfaction, and value of care.
* Upside-only bundles are a payment system where providers are paid a fixed amount for a bundle of services related to a specific condition or episode of care, such as a hip replacement or a hospitalization.
This payment system carries a low financial risk for providers, as they can only share in the savings if they deliver the bundle of services at a lower cost than the fixed amount, but they do not have to bear any losses if they exceed the fixed amount. However, this payment system may also create incentives for coordination, standardization, and efficiency of care.
References:
* Benefits of Risk-Based Payments: How Healthcare Data Improves Profits
* The future of the payments industry: How managing risk can drive growth
* Financial crime risk management in digital payments
質問 # 63
A quality professional has been asked to assist with prioritizing quality performance Initiatives In the surgery department.
Given the Information In the matrix below, which of the following performance Initiatives should take priority?
- A. Reduce surgical site Infections.
- B. Reduce unplanned readmissions.
- C. Reduce blood transfusion reactions.
- D. Reduce urinary tract Infections.
正解：A
解説：
According to the provided matrix, surgical site infections have high relative weight in both risk and volume, and also score the highest in terms of cost, indicating that they are frequent, carry significant risk, and are costly. While customer satisfaction is lower for urinary tract infections (UTIs), the higher relative weight and cost associated with surgical site infections suggest they have a more significant impact on overall quality and resource use. Therefore, focusing on reducing surgical site infections aligns with prioritizing initiatives that have the potential for the greatest impact on patient safety and resource utilization.
Reference: This recommendation is consistent with the NAHQ's emphasis on using data to prioritize quality initiatives, focusing on areas that have the highest impact on patient outcomes and healthcare costs. The NAHQ Healthcare Quality Competency Framework also discusses the importance of data analysis in the Performance and Process Improvement domain to prioritize improvements in healthcare quality and safety.
質問 # 64
A patient safety program can best be enhanced by which of the following technologies?
- A. computers on wheels at the patients' bedsides
- B. online evidence-based medicine guidelines
- C. barcode system for medication administration
- D. digital medication reference materials
正解：C
質問 # 65
Basically an operational definition is a description in quantifiable terms, of what to measure and the specific steps needed to measure it constantly.
A good operational definition:
- A. Is no doubt clear but somewhat ambiguous
- B. Gives communicable meaning to a concept or an idea
- C. Enables consistently in data collection
- D. Is a decision-making criteria
正解：B、C
質問 # 66
Prior to implementing a new patient service, the healthcare quality professional should recommend
- A. conducting a root cause analysis (RCA).
- B. performing just-in-time staff safety training.
- C. developing a safety monitoring checklist.
- D. initiating a failure modes and effects analysis (FMEA).
正解：D
解説：
Before implementing a new patient service, the healthcare quality professional should recommend conducting a Failure Modes and Effects Analysis (FMEA). FMEA is a proactive tool used to identify potential failure points in a new process or service before they occur. This analysis helps to prioritize risks based on their severity, occurrence, and detectability, and to implement corrective actions to mitigate these risks. By using FMEA, the organization can enhance patient safety by addressing potential problems before they affect patients.
Developing a safety monitoring checklist (A): While useful, this step comes after identifying potential risks and failure modes through FMEA.
Conducting a root cause analysis (RCA) (B): RCA is a reactive tool used after an adverse event occurs, making it unsuitable for proactive risk assessment before implementing a new service.
Performing just-in-time staff safety training (D): While important, this should follow the identification of risks and implementation of safety measures based on the FMEA findings.
Reference
NAHQ Body of Knowledge: Risk Management and Patient Safety
NAHQ CPHQ Exam Preparation Materials: FMEA Process and Application
質問 # 67
A healthcare quality professional can conclude that clinical performance measuresindisease specific certification programs are best supported by the
- A. compliance committee.
- B. regulatory requirements.
- C. licensing requirements.
- D. practice guidelines.
正解：D
解説：
Clinical performance measures in disease-specific certification programs are best supported by practice guidelines. These guidelines provide a framework for continuously reliable care. The Joint Commission's commitment to this certification ensures your program meets clinical performance standards for targeted metrics as well as other compliance standards1. Disease-specific certification helps reduce unwanted variations in care and improve the patient experience, improve efficiencies and outcomes at a potential lower cost1. Therefore, practice guidelines play a crucial role in supporting these measures.
References: 1
質問 # 68
In the 1970s, Deming developed his 14 points for western Management in response to requests from U.S.
managers for the secret to the radical improvement that Japanese companies were achieving in a number of industries. As part of his "system of profound knowledge," Deming promoted that "around 15% of poor quality was because of workers, and the rest of 85% was due to bad management, improper systems and processes." The "system" is based on parts.
Which of the following is/are NOT out of those parts?
- A. Knowledge about variation
- B. Appreciation for a system
- C. Theory of knowledge
- D. Sociology
正解：D
質問 # 69
An interdisciplinary learn met to review readmission rates at a health system. Issues were identified with communication across care providers.
The team is interested in improving the coordination of care process and is now reviewing four candidates to serve in the role of process champion:
Of the four candidates, which represents the most effective choice to serve as a process champion?
- A. Candidate C
- B. Candidate B
- C. Candidate A
- D. Candidate D
正解：B
質問 # 70
For which incident would a process improvement manager be required to perform a root cause analysis (RCA)?
- A. Procedure performed on the wrong knee.
- B. Incorrect critical care patient transported to radiology.
- C. Wrong prescription given to a discharged patient with diabetes.
- D. Admitting a visitor who fell on hospital grounds.
正解：A
解説：
A root cause analysis (RCA) is required when a serious incident occurs, such as a "never event" or a sentinel event, which includes a procedure performed on the wrong knee. This type of incident is considered a significant error that could cause severe harm to the patient and is a clear indicator of a breakdown in the system that requires thorough investigation through an RCA to prevent recurrence.
* Incorrect critical care patient transported to radiology (A): While concerning, this may not reach the threshold for a required RCA unless it led to significant harm.
* Admitting a visitor who fell on hospital grounds (B): This incident may require investigation but typically would not trigger an RCA unless the fall resulted in severe injury.
* Wrong prescription given to a discharged patient with diabetes (C): This is serious but does not usually require an RCA unless it led to severe consequences.
References
* NAHQ Body of Knowledge: Incident Reporting and Root Cause Analysis
* NAHQ CPHQ Exam Preparation Materials: Conducting Root Cause Analysis
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質問 # 71
Knowledge about _______ is crucial to making valid judgments about quality of care using either process or outcome
measures. If we know that a given clinical intervention was undertaken in circumstances that match those, under
which the intervention has been shown to be efficacious, we can be confident, that the care was appropriate and, to
the extent of good quality.
- A. Efficacy
- B. Structure
- C. Processes
- D. Outcomes
正解：A
質問 # 72
An organization has compiled the scatter plots below:
Based on these plots, which of the following conclusions can be made by the quality professional?
- A. Complication rates are not causing longer time to positive outcome at setting 2.
- B. Setting 1 has a strong positive correlation between complication rate and time to positive outcome.
- C. Complication rates are causing longer time to positive outcome at settling 1.
- D. Setting 2 has a significant correlation between complication rate and time to positive outcome.
正解：B
解説：
A scatter plot is a graphical tool that shows the relationship between two continuous variables by plotting data points at their corresponding values on the x-axis and y-axis1.
To interpret a scatter plot, we need to look at the direction, strength, and shape of the relationship between the variables2.
The direction of the relationship indicates whether the variables tend to increase or decrease together (positive correlation) or in opposite directions (negative correlation).
The strength of the relationship indicates how closely the data points cluster around a line or curve that best fits the data. A common measure of the strength of the linear relationship is the correlation coefficient , which ranges from -1 to 1. The closer the absolute value of R is to 1, the stronger the linear relationship2.
The shape of the relationship indicates whether the data points follow a straight line (linear relationship) or a curved pattern (nonlinear relationship).
Based on these criteria, we can analyze the scatter plots for Setting 1 and Setting 2 as follows: Setting 1:
The scatter plot shows a clear upward trend, indicating a positive correlation between complication rate and time to positive outcome. The data points are tightly clustered around a line, indicating a strong linear relationship. The R^2 value of 0.9533 on the plot is close to 1, which means that the linear model explains 95.33% of the variation in the complication rate. Therefore, we can conclude that Setting 1 has a strong positive correlation between complication rate and time to positive outcome.
Setting 2: The scatter plot shows a scattered pattern, indicating a weak or no correlation between complication rate and time to positive outcome. The data points are widely spread around a line, indicating a weak linear relationship. The R^2 value of 0.4923 on the plot is far from 1, which means that the linear model explains only 49.23% of the variation in the complication rate. Therefore, we cannot conclude that Setting 2 has a significant correlation between complication rate and time to positive outcome, or that complication rates are causing longer time to positive outcome at setting 2.
Reference: 1: 8.8 Scatter Plots, Correlation, and Regression Lines 2: Scatterplots: Using, Examples, and Interpreting
質問 # 73
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