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CHDA EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS
______ is the combination of certain items (such as anesthesia, supplies, and drugs) for the purpose of reimbursement. Correct Answers Packaging Packaging means that payment for that service is packaged into payment for other services and, therefore, there is no separate APC payment. Packaged services might include minor ancillary services, inexpensive drugs, medical supplies, and implantable devices (LaTour et al. 2013, 437).
. An analyst was testing the hypothesis that there is an association between physician gender (M/F) and the willingness to use/not use CPOE. The value of the chi-square test statistic is 7.23. If the acceptable level of type I error was set to 0.01, what is the conclusion of the hypothesis test? Chi-squared with One Degree of Freedom Critical Values Alpha level X2 Critical Value (df = 1) 0.1 2. 0.05 3. 0.025 5. 0.01 6. 0.005 7.879 Correct Answers Reject the null hypothesis An extreme value for a test statistic is indicative of a statistically significant result. For the chi-squared test, the value of the test statistic should be compared to the chi-squared distribution with one degree of freedom to determine the probability of
incorrectly rejecting the null hypothesis is less than our pre set alpha level (White 2013, 62).
. In which of the following phases of systems selection and implementation would the process of running a mock query to assess the functionality of a database be performed? Correct Answers Testing Running a mock query would be part of application testing that ensures that every function of the new computer system works. Application testing also ensures that the system meets the functional requirements and other required specifications in the RFP or contract (Sayles and Trawick 2010, 142). "Not Elsewhere Classified" should not appear in a clinical terminology because it results in _____. Correct Answers Imprecise data Not Elsewhere Classified (NEC) is not the same as Not Otherwise Specified (NOS). NOS means that there is no additional information. NEC means you have more information but no place to put it. (LaTour et al. 2013, 405). 30-day mortality rates are considered a(n): Correct Answers Outcome of care measure Mortality is considered an outcomes measure in the CMS value based purchasing program.
A current key function in the health information field whereby data is turned into useful information is: Correct Answers Data analytics The term data analytics is used to describe a variety of approaches to using data to make business decisions. Healthcare data analytics is therefore the practice of using data to make business decisions in healthcare. More specifically, healthcare data analytics is the application of statistical techniques to allow informed decisions to be made based on the data (LaTour et al. 2013, 525). A database contains two tables: physicians and patients. If a physician may be linked to many patients and patients may only be related to one physician, what is the cardinality of the relationship between the two tables? Correct Answers One-to- many The one-to-many relationship exists when one instance of an entity is associated with many instances of another entity. If a physician may be linked to many patients and patients may only be related to one physician, this is an example of a one-to-many relationship (Sayles and Trawick 2010, 96). A database rule that states "patient gender must be recorded as M=male, F=female, U=unknown" is referred to as _____________. Correct Answers Integrity constraint Databases contain rules known as integrity constraints that must be satisfied by stored data (LaTour et al. 2013, 187).
A director of a health information services department plans to do a research project on motivation that involves rewarding some employees for achieving specified goals. A control group will not be rewarded for achieving the same goals. Which entity will need to approve this study? Correct Answers Institutional Review Board The Institutional Review Board (IRB) is a committee established to protect the rights and welfare of human research subjects involved in research activities. The IRB determines whether research is appropriate and protects human subjects as they participate in this research. The primary focus of the IRB is not on whether the type of research is appropriate for the organization to conduct but upon whether or not human subjects are adequately protected (LaTour et al. 2013, 580). A discharge date for a patient can only be entered into a database after a PATIENT has been created. This concept is referred to as __________. Correct Answers Referential integrity Constraints placed on the primary and foreign keys within the database. A foreign key, for example, cannot be entered into the database unless a corresponding primary key already exists. A primary key is an essential attribute within the database that is used to link cases or records together or to query the database for specific information. This concept is called referential integrity. In this case, the 'patient' id represents the primary key and the discharge date is a foreign key (Pratt and Adamski 2008; LaTour et al. 2013, 187).
A key principle for healthcare delivery and information management in the 21st century is _____. Correct Answers Collect data once and use it multiple times A key tenet for healthcare delivery in the 21st century is to collect information once at the point of care and repurpose it many times for a variety of health-related needs (LaTour et al. 2013, 223). A key technology in the development of a universal language to aid storage and transmission of Web-based data is ____. Correct Answers XML A key technology tool for enabling data sharing is called extensible markup language. XML was developed as a universal language to facilitate the storage and transmission of data published on the Internet (LaTour et al. 2013, 212). A line chart is the best display of: Correct Answers The average length of stay by month for the last year Line graphs can also be referred to as run charts in the quality management field. Line graphs display time trends (White 2013, 49). A measure of variability that describes the deviation from the mean of a frequency distribution in the original units of measurement is called the: Correct Answers Standard deviation
The standard deviation is the most widely used measure of variability in descriptive statistics. The standard deviation is easy to interpret and is the most preferred measure of dispersion for frequency distributions (LaTour et al. 2013, 520; Shaw and Carter 2014, 120, 223). A one-sample z-test for proportions may be used to: Correct Answers Determine if the mortality rate at one hospital is different from a standard The test statistic used to compare a proportion to a standard is called the one sample Z-test for proportions (White 2013, 68). A patient born with a neural tube defect would be included in which type of registry? Correct Answers Birth defects Birth defects registries collect information on newborns with birth defects. Often population based, these registries serve a variety of purposes. For example, they provide information on the incidence of birth defects to study causes and prevention of birth defects, to monitor trends in birth defects to improve medical care for children with birth defects, and to target interventions for preventable birth defects such as folic acid to prevent neural tube defects (LaTour et al. 2013, 373). A primary key in a table: Correct Answers Must be unique for each row in the table The primary key uniquely identifies the row in the database (White 2013, 180).
while a nomenclature supports detailed descriptions (LaTour et al. 2013, 388-389; AHIMA 2014, 103). A research instrument that is used to gather data and information from respondents in a uniform manner through the administration of a predefined and structured set of questions and possible responses is called a(n): Correct Answers Survey A survey is a common tool used in performance improvement to assess the level of satisfaction with a process by its customers. When designing a survey, the PI team must define the goal of the survey in clear and precise terms (Shaw and Elliott 2012, 98- 101; Shaw and Carter 2014, 117, 221). A researcher mined the Medicare Provider Analysis Review (MEDPAR) file. The analysis revealed trends in lengths of stay for rural hospitals. What type of investigation was the researcher conducting? Correct Answers Secondary analysis Secondary analysis is the analysis of the original work of others. In secondary analysis, researchers reanalyze original data by combining data sets to answer new questions or by using more sophisticated statistical techniques. The work of others created the MEDPAR file (LaTour et al. 2013, 569). A researcher would like to test the null hypothesis that the mean wait time at four urgent care sites is equal. What statistical test should the researcher use in this situation? Correct Answers ANOVA
The statistical tool used to compare more than two populations is called an analysis of variance (ANOVA). The null hypothesis for an ANOVA is that the population means to be compared are equal (White 2013, 92). A revenue code represents a: Correct Answers Facility department The revenue code represents a standardized department in a facility and is required for each charge line when billing services to Medicare (White 2013, 20). A set of scenarios that describes an interaction and potential outcomes between a user and a system is called a(n): Correct Answers Use case A use case is a set of scenarios that describes an interaction between a user and a system. A use case diagram displays the relationship among actors and use cases. The two main components of a use case diagram are use cases and actors. An actor represents a user or another system that will interact with the system being modeled. A use case is an external view of the system that represents some action the user might perform in order to complete a task (LaTour et al. 2013, 230). A(n) _____ is developed outside the framework of a specific database and is used to define individual data elements used throughout a healthcare facility. Correct Answers DBMS data dictionary
Clinical information is data that are related to the patient's diagnosis or treatment in a healthcare facility (Odom-Wesley et al. 2009, 55). All of the following are types of decision support systems (DSS), except _____. Correct Answers Point-of-care information systems Decision support systems (DSSs) are interactive computer systems that intend to help decision makers use data and models to identify and solve problems and make decisions. A great deal of innovation is occurring related to DSSs, and the technologies of which they are comprised are changing rapidly (LaTour et al. 2013, 94). All of the following is a kind of technology that focuses on data security except _____. Correct Answers Smart Cards Security includes "physical and electronic protection of the integrity, availability, and confidentiality of computer-based information and the resources used to enter, store, process, and communicate it; and the means to control access and protect information from accidental or intentional disclosure" (Harman 2006, 635). An analyst wishes to determine the amount of time coders require to code inpatient records. She samples all records from 10 randomly selected dates. This is an example of Correct Answers Cluster sampling
Cluster sampling may be performed as single-stage or two-stage versions. In single-stage cluster sampling, clusters are selected at random and all units in that cluster are included in the sample. An example of single-stage cluster sampling is to randomly select a day in the month and select all cases coded on that day as the sample (White 2013, 122). An analyst wishes to test the hypothesis that the wait time in the emergency department is longer on weekends than weekdays. What is the alternative hypothesis? Correct Answers The average wait time is longer on weekends. The alternative hypothesis is the compliment of the null hypothesis and typically requires some action to be taken. In this scenario, the analyst is comparing emergency department wait times between weekends and weekdays. The alternative hypothesis would be that the average wait time is longer on weekends (White 2013, 60). An analyst wishes to test the impact of a new patient schedule system on number of MRI tests performed per day. What statistical test should be used? Correct Answers Paired t-test A paired t-test may be used to compare a variable measured at two time points on the same subject (White 2013, 86). An audit trail is a good tool for which one of the following? Correct Answers Reconstructing electronic events
stored as characters, words, symbols, measurements, or statistics. Unprocessed data are not very useful for decision making (LaTour et al. 2013, 170). An HIM director wants to conduct research to learn about the physicians' view of the department's image. What type of scale should she use to collect data? Correct Answers Semantic differential scale Researchers, marketers, and others use a semantic differential scale to ascertain a group's perspective or image of a product, healthcare organization, or program (LaTour et al. 2013, 577). An internal link that allows only the employees of a particular organization to navigate and communicate in a web-based environment is a(n): Correct Answers Intranet Intranets link every employee within an organization via an easy-to-navigate, comprehensive network devoted to internal business operations. Intranets are designed to enhance communication among an organization's internal employees and facilities. Web-based intranets offer better security than use of the "public" Internet and are less expensive to implement and easier to use than most private networks of proprietary mail and messaging software products (LaTour et al. 2013, 91-92). Analyzing patterns of care can help identify Missed charges Over coding
Under coding All of these Correct Answers All of these Any pattern of care that has a potential relationship can be analyzed. For example, when analyzing coding patterns in the emergency department (ED), the analyst may evaluate cases in which patients were assigned to APC 0616, Level 5 ED visit, and APC 0617, critical care, but were not admitted. Through the evaluation, the analyst can attempt to determine the reasons why the patients were not admitted. Logic would seem to state that the sickest of all patients presenting to the emergency department would have resulted in inpatient admission, with the exception of patients who expired in the emergency department (White 2013, 149). Anywhere Hospital has mandated that the social security number will be displayed in the XXX-XX-XXXX format for their patients. This is an example of the use of a: Correct Answers Mask The data dictionary may also control if a mask is used and if so, what form it takes. The social security number of 123456789 could be entered and it appears in the system as 123-45-6789. The use of the mask tells the database what format to use to display the number (Sayles and Trawick 2010, 94 ASTM Standard E1384-07 provides guidance to healthcare organizations in developing _____. Correct Answers Content and structure of health records
As healthcare organizations throughout the country have become more computer savvy, so too has the federal government. The data-mining efforts of the recovery audit contractors (RACs) allow them to deny payments without ever reviewing a health record. For example, duplicate billing, such as billing for two colonoscopies on the same day for the same Medicare beneficiary, is easy to identify as a potential improper payment. Through the use of the RACs' proprietary software, RACs are able to detect improper payments. Underpayment and overpayment amounts can be subject to an automated review (Wilson 2010, 15-16; Shaw and Carter 2014, 147, 238). Benchmarking may be used to: Correct Answers Determine areas of improvement The American Productivity and Quality Center (APQC) describes benchmarking as "the process of improving performance by continuously identifying, understanding and adapting outstanding practices and processes found inside and outside the organization" (APQC 1999; White 2013, 161). Binary variables are useful in calculating Rates Proportions Percentages All of these Correct Answers All of these
A special case of a categorical variable is a binary variable. A binary variable has two values: yes or no. Most rates used in healthcare are based on binary variables (White 2013, 55). Bob Jones is considering contractors for his company's medical benefits, and he is reviewing health plans from two different entities. Which of the following databases should he consult to compare the performance of the two health plans? Correct Answers HEDIS The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of standard performance measures designed to provide purchasers and consumers of healthcare with the information they need for comparing the performance of managed healthcare plans (LaTour et al. 2013, 200; Shaw and Carter 2014, 49, 182). By querying the healthcare entity data, you find that patients admitted on a weekend have a mean length of stay that is 1. days longer than patients who are admitted Monday through Friday. This method of finding information is called: Correct Answers Data mining Data mining is the process of sorting through the organization's data to identify unusual patterns or to apply analytical models that will assist in predicting future events. Current applications of data-mining activities in healthcare include models to support fraud detection, utilization review, and clinical pathways (LaTour et al. 2013, 86; Shaw and Carter 2014, 19, 169).
