The 5 Books I Recommend for CPHQ Exam Preparation

I was always anxious how to make a good preparation for my CPHQ exam. I actually collected many study resources. During course of my study I gradually realized 5 important resources and then I stuck to only them till the Exam. After successfully clearing exam I can confidently say that these study resources are the best set for any CPHQ aspirant. 

My 5 Recommended CPHQ Exam Preparation Resources

1. HQ Solutions: Resource for the Healthcare Quality Professional

2. The Healthcare Quality Handbook

3. CPHQ Study Guide: CPHQ Exam Prep and Practice Test Questions

4. The Quality Toolbox

5. CPHQ Exam Practice Questions

  Salient Pointers of Each Study Resource in Brief: 

1. HQ Solutions: Resource for the Healthcare Quality Professional

For comprehensive guidance on creating quality structures that support patient/provider collaboration, cost-effective solutions, and safe, efficient care, get the fully updated HQ Solutions, an official publication of the National Association for Healthcare Quality (NAHQ).

2. The Healthcare Quality Handbook

This Handbook provides the most current information available for those seeking a comprehensive look at the field of healthcare quality or preparing for CPHQ Certification. This unique handbook should be available to every health care quality professional who wishes to recognise and have access to the large body of ideas and methods now available for improvement. It should become available on computer disk in the future.

3. CPHQ Study Guide: CPHQ Exam Prep and Practice Test Questions

Anyone planning to take this exam should take advantage of this Test Prep Books study guide. Purchase it today to receive access to: CPHQ review materials, CPHQ practice questions & Test-taking strategies

4. The Quality Toolbox

The Quality Toolbox is a comprehensive reference to a variety of methods and techniques: those most commonly used for quality improvement, many less commonly used, and some created by the author and not available elsewhere. The reader will find the widely used seven basic quality control tools (for example, fishbone diagram, and Pareto chart) as well as the newer management and planning tools. Tools are included for generating and organizing ideas, evaluating ideas, analyzing processes, determining root causes, planning, and basic data-handling and statistics. The Quality Toolbox is an essential tool that you won’t want to misplace. The real strength of this book, though, is in the individual tools collection – there are more than 85.

5. CPHQ Exam Practice Questions

Practice is an important part of preparing for a test and improving your chance of success and practice questions are designed to prepare you for the real test. You could know everything that is going to be covered on the test but still perform poorly if you have never worked with CPHQ practice questions. Being familiar with the different types of questions and answer choices that you might see on the official test is a big advantage.

What You Can Do

Measures will also gain value as more people become involved. Here are steps anyone can take:

• Ask your providers how they measure and report results to improve care and raise awareness among patients.
• Use HospitalCompare.HHS.gov, Medicare.gov/NHCompare, some of the AF4Q examples, and other public reporting venues to learn about providers’ performance. Share the information with your friends and family.
• Participate in NQF’s public comment periods.
• Nominate or serve on an NQF Steering Committee.
• Attend public meetings (in person or virtually).

Your comments matter 

Public input plays an important role in NQF’s decisions about measure endorsement. One example comes from debate about endorsing a measure for the proportion of patients who achieve 20/40 vision through cataract surgery. The committee was leaning against endorsement, but public comments suggested greater variability in outcomes among physicians and patient groups than research was showing. As a result, NQF endorsed the measure, which will help us learn more about outcomes of this surgery, especially in non-academic and community hospitals. The answers have high stakes since more than half of all Americans have the procedure by age 80. 

The ABCs of Measurement was developed with support from the Robert Wood Johnson Foundation.

How Measures Will Serve Our Future

Measures are becoming both more precise and more complex. The next generation of measures will span healthcare settings and episodes of care to present a more complete picture of care. In the public arena, reporting of measures will become clearer and easier for patients and their families to understand and use.

Wider adoption of electronic health records (EHRs) can spur measure use enormously. A tremendous boon for patient care and patient experience, EHRs put all the relevant information, including a patient’s medical history, at a provider’s fingertips. Patients can avoid duplicate tests or imaging. EHRs will also make measurement and performance data available on a real-time basis, making healthcare much more responsive to patient needs. Without good data, healthcare systems simply cannot accurately measure and assess performance.

Learn what you can do.

Patient-Centered Measures = Patient-Centered Results

Let’s face it. Nobody wants to be in a hospital. The lost sense of independence and control is… at best, unpleasant. A winner of NQF’s National Quality Healthcare Award, North Shore-Long Island Jewish Health System (LIJ) shifts power back to patients through extraordinary performance measurement of patient care and satisfaction and public reporting of results. Not surprisingly, the practice of continuous measurement and public reporting creates a feedback loop that improves patient care.

“At North Shore-Long Island Jewish we believe that we must earn patients’ trust by reporting our outcomes and errors and enabling them to make informed decisions about which provider to choose.” 

Kenneth Abrams, MD, Senior Vice President of Clinical Operations at North Shore-LIJ 

What You Say Matters

What patients say about care really matters at North Shore-LIJ. Patients, families, and community members are actively engaged in improving quality by reporting errors, near misses in their care, and complaints. North Shore routinely includes patients in advisory positions when a major decision about patient care is on the table. A database tracks all patient feedback, which system leaders then use to identify trends and determine priorities for improvement. Areas of concern are boldly reported across the system from the boardroom to doctors, nurses, and support staff.

The results are impressive. Using a video-monitoring program that displays progress on priorities throughout the hospital, North Shore-LIJ increased hand-washing compliance by 81 percent. The hand-hygiene vigilance undoubtedly contributed to a 60-percent drop in infections associated with central lines, a 45-percent reduction in Clostridium difficile infection rates (from 1.74 to 0.95 percent), and an 80-percent decrease in Methicillin-resistant Staphylococcus aureus infection rates (0.35 percent to 0.07 percent).

Better communication with patients is also helping to ensure that patients who are discharged from North Shore-LIJ get and stay better. After implementing a process of weekly, post-discharge phone calls to heart-failure patients, one North Shore-LIJ hospital reduced its readmission rate from 32 percent to 9 percent — saving money and giving more patients precious time at home. Medicare reports that unplanned return visits to hospitals generate $17 billion in unnecessary costs each year.

Quality, Front and Center

North Shore-LIJ’s commitment to measurement, transparency, and patient-centered care is front and center for all 38,000 employees, from the parking valets to surgeons. CEO and President Michael Dowling meets with every new employee to present the system’s quality improvement dashboard, which lays out the organization’s quality measures, performance targets, and results.

“Quality is not a department. It’s not just one process,” said Dowling. “It is everyone’s business. You want it to be part of the DNA of the organization.”

Investing in EHRs

Dowling is working to spread performance measurement and quality improvement beyond the walls of North Shore-LIJ through a $400 million investment in an electronic health record (EHR) system for inpatient and outpatient settings. The healthcare system is subsidizing community physicians’ purchase of EHRs with the condition that their performance on quality measures be shared. It’s another extraordinary display of the system’s commitment to transparency and improvement. Under the new integrated program, North Shore-LIJ will provide physicians with feedback that shows where their performance falls in comparison to doctors nationwide and in their community.

Learn what NQF endorsement means.

The Right Tools for the Job

Just as a ruler can’t determine air temperature, different measures prove useful for different jobs. Some measures focus on specific steps in providing care, such as whether heart attack patients receive prescriptions for beta blockers and antilipid medications at discharge. Other measures use a wide-angle lens to look at results — for example, whether patients sent home from the hospital have improved health or end up coming back with complications that could have been avoided. Each tool provides a different view — assessing performance from a specific angle. The more we see, the more information we have to choose wisely and make improvements.

NQF endorses a portfolio of tools designed to create a way of seeing and knowing whether care is achieving defined benchmarks.

Process Measures show whether steps proven to benefit patients are followed correctly. They measure whether an action was completed — such as writing a prescription, administering a drug, or having a conversation. Examples:
 

Universal Documentation and Verification of Current Medications in the Medical Record	Percentage of patients whose medical record contains a list of current medications with dosages verified with the patient or authorized representative.
Initial antibiotic received within 6 hours of hospital arrival	Percentage of patients with pneumonia who receive their first dose of antibiotics promptly after arrival at the hospital.
Cervical Cancer Screening	The percentage of women who had a cervical cancer screening with a Pap test.
Childhood Immunization Status	Percentage of children 2 years of age who had four DtaP/DT, three IPV, one MMR, three H influenza type B, three hepatitis B, one chicken pox vaccine (VZV), and four pneumococcal conjugate vaccines by their second birthday.

Outcomes Measures take stock not of the processes, but of the actual results of care. They are generally the most relevant measures for patients and the measures that providers most want to change. Examples: 

Falls with injury	Rate of patient falls with injury in a hospital.
Surgical Site Infections	Percentage of surgical site infections occurring within 30 days after the operative procedure.
Controlling High Blood Pressure	Percentage of hypertension patients whose blood pressure is under control.
Acute Myocardial Infarction 30-day Mortality	Rate of deaths from any cause within 30 days after hospitalization for a heart attack.
Body Mass Index (BMI) in adults > 18 years of age	Percentage of adults who had an evaluation of their weight.

Patient Experience Measures record patients' perspectives on their care. Examples: 

CAHPS Clinician/Group Surveys — (Adult Primary Care, Pediatric Care, and Specialist Care Surveys)	Surveys of patient experience with primary care for adults and children and with specialist care.
HCAHPS	Patient experience with care survey for patients who have been in the hospital.
Family Evaluation of Hospice Care	Family Evaluation of Hospice Care.

 Structural Measures reflect the conditions in which providers care for patients. These measures can provide valuable information about staffing and the volume of procedures performed by a provider. Examples: 

Nursing Care Hours per Patient Day	Number of productive hours worked by nursing staff with direct patient care responsibilities per patient day.
Adoption of Medication e-Prescribing	Documents whether provider has adopted a qualified e-prescribing system and the extent of use in the ambulatory setting.
Medical Home System Survey	Percentage of practices functioning as a patient-centered medical home by providing ongoing, coordinated patient care.

 Composite Measures combine the result of multiple performance measures to provide a more comprehensive picture of quality care. Examples: 

Mortality for Selected Conditions	Measure of in-hospital mortality indicators for selected conditions.
Pediatric Patient Safety for Selected Indicators	Measure of potentially preventable adverse events for selected pediatric indicators.

Learn how patient-centered measures = patient-centered results.

Choosing What to Measure

So much of healthcare benefits from good measures. How do we figure out which measures can give us the biggest return in better quality of life for patients? Who sets the priorities, and who carries them out?

Since 2008, the National Priorities Partnership, a group of 48 organizations convened by NQF, has helped galvanize healthcare’s expansive and fragmented system around priorities and goals where concerted action makes the biggest difference for patients. Initial priorities have been patient and family engagement, care coordination, safety, population health, overuse, and palliative and end-of-life care. At the request of HHS, NPP has provided feedback on the proposed National Quality Strategy and stands ready to assist with alignment of private-sector initiatives with the Secretary’s initial plan. NPP’s recommendations built on its initial focus to encompass such areas as equal access to care and critical foundations, including health information technology and a strong evidence base, essential to improve results for patients.

The national priorities guide NQF’s agenda for endorsement of standards and educational outreach to its members. In addition, NQF is convening panels of stakeholders, including consumer representatives, from across the healthcare arena to identify areas where new measures are especially needed.

Locally, healthcare systems can turn to NPP priorities for guidance as they develop or customize measures to address the needs of their specific patients. Regionally, communities may select measures to focus on better outcomes for patients at risk in their populations — say, Latinos with diabetes. Professional societies create measures to support their members in achieving standards of care, as the Society of Thoracic Surgeons has done, and health plans develop measures to guide what they pay for and how much they pay.

It is a complex landscape, but one benefitting from increased collaboration as healthcare leaders work together to use measures to drive better health for Americans.

Humboldt County’s Care Transitions Program addresses NPP’s priority for care coordination: Ensure patients receive well-coordinated care within and across all healthcare organizations, settings, and levels of care. 

Learn the right tools for the job.

The Difference a Good Measure Can Make

Healthcare professionals work hard to deliver skilled, thoughtful care. But no one person can see across the complexity of the healthcare enterprise to make sure the end result adds up to the best patient care. Measures light the way, showing where systems are breaking down and where they are succeeding to help patients get and stay well.

Why Measure?

Measures drive improvement. Teams of healthcare providers who review their performance measures are able to make adjustments in care, share successes, and probe for causes when progress comes up short — all on the road to improved patient outcomes.

Measures inform consumers. As a growing number of measures are publicly reported, consumers are better able to assess quality for themselves, and then use the results to make choices, ask questions, and advocate for good healthcare. Some providers now post performance measures on their websites, and consumers can consult national sources such as HospitalCompare.gov and NursingHomeCompare.gov.

Measures influence payment. Increasingly, private and public payers use measures as preconditions for payment and targets for bonuses, whether it is paying providers for performance or instituting nonpayment for complications associated with NQF’s list of “Serious Reportable Events.”

“Measurement matters. When clinicians see their numbers, they act to improve them, using their professional pride and competitiveness to find solutions.” - Randall D. Cebul, MD , Director, Better Health Greater Cleveland

Learn how we choose what to measure.