Pre-Assessment
A health services coordinator is working with a patient who has a history of diabetes and has just returned home after being hospitalized for sepsis from a wound on the leg. The coordinator wants to utilize a strengths-based model to encourage the patient. Which topic reflects this model?
Achieving optimum health
The spouse of a patient has requested admission to a rehabilitation facility owned by a friend. The case manager has had several interactions with the facility and has received negative feedback from previous residents. Regardless of the feedback, the manager establishes care with the rehabilitation facility selected by the family. Which Case Management Society of America's (CMSA) standard has been violated?
Advocacy
A case manager in a home healthcare organization has a caseload of 10 post-myocardial infarction (MI) patients. The case manager applies the patient-centered care model. What is the goal of this model?
Advocate for patient needs
The case manager meets with a patient who is not allowed to eat from sunrise to sunset since entering a religious holiday. Since the patient is on many medications throughout the day that must be taken with food, compliance issues have been occurring. The manager is attempting to use the guidelines from the Case Management Society of America (CMSA) to solve the problem. Which client-centric management direct approach should be used by the manager to meet this goal?
Alert the physician in case there may be long-acting alternative medications
A health services coordinator working at a behavioral clinic needs to use a personal cell phone to transfer patient information and arrange services due to a telephone outage at the clinic. Which action should this coordinator avoid?
Allowing the patient to use the phone under proper supervision
A 23-year-old female comes into the clinic for evaluation. As she is talking with the coordinator, the patient begins to cry and tell the coordinator she is being physically abused by her live-in boyfriend. Which action should the coordinator take next?
Ask the client if she has a safe place she can go
A telephonic case manager is using open-ended questions during a conversation with a client that has not followed up with a scheduled primary care appointment. Which of the five core competencies is being reflected?
Assessment of factors impacting care
A rural hospital has recently transitioned from paper charting to electronic medical records (EMRs). Several experienced staff members have complained that they are not computer literate, and they are contemplating resigning. Which action should the supervisor take to assist these employees?
Assign super users to assist the employee's
A hospital has a committee that monitors that treatment of sepsis patients, consistent with regulations from the Centers of Medicare and Medicaid Services (CMS). What is the first step in this process?
Chart reviews
A new clinical case manager working in an outpatient clinic has just received a six-month competency review. It is noted that further experience is needed in the domain of care delivery and reimbursement methods. Which patient diagnosis supports this development?
Chronic lung disease; needs to apply for disability
A health services coordinator is formulating a care plan for a patient with end-stage kidney failure. The patient recalls the physician saying a kidney transplant is a life-saving option for them. The patient's spouse says the physician did not recommend surgery due to the patient's fragile condition. This difference of opinion is causing conflict and preventing the creation of a care plan. What is the first step the coordinator should take to resolve this conflict?
Clarify factual information
With the move to value-based care, a large practice network has asked its newly hired health services coordinator to educate staff on a patient shared decision-making model. Which practice illustrates this model?
Clinicians and patients work together to make treatment decisions.
A health services coordinator is working with a 60-year-old patient who has a long history of alcohol abuse and noncompliance with general medical conditions. The coordinator is helping a new employee identify the actions that should be taken to assist this patient. Which action should be identified?
Collaborating between disciplines
A new case manager is working with a preceptor on a difficult case where the client needs skilled respite care, meals, and personal hygiene. The goal is to achieve optimum value and desirable outcomes for the client. Which competency should be used by the manager?
Collaboration with all services
After a problem on a hospital unit was discovered, the unit created a quality improvement team to manage the issue. The team reviewed and appraised the evidence, and that report led to the development of an approved policy to combat the problem. What is the next step in the evidence-based practice (EBP) process for this quality improvement team?
Communicate the policy with the staff
A health services coordinator is meeting with two family members of a patient with terminal cancer. One family member is from an ethnic culture in which it is important to avoid uncertainty, and another member is from a culture more comfortable with trying new approaches. These cultural differences are making it difficult for the coordinator to obtain consensus on a care plan for the patient. Which tactic should the coordinator employ to resolve this conflict?
Compromise
A health services coordinator at a long-term acute care hospital has orders to set up family counseling for a stroke patient and family. The patient speaks only French, and the family speaks very limited English. Which set of topics should the coordinator address at the first meeting?
Cultural issues and multilingual translation
A psychiatrist in a private office has assessed a client and determined that symptoms of post-traumatic stress disorder and schizophrenia are present. Which industry coding classification toll should be used as a resource to help make the proper diagnosis?
DSM 5
An uninsured patient presents at the emergency department (ED) with a fractured tibia, but there is no orthopedic provider available. The administrator is arranging transfer to another hospital, but the receiving facility with an orthopedic on call refuses to accept the patient. Which law was violated by the receiving facility?
Emergency Medical Treatment and Active Labor Act (EMTALA)
The health services coordinator has developed an evidence-based practice project with the intention of reducing inpatient length of stay. The outcome of the project resulted in patients being discharged from the hospital before they were ready, which was not the intention of the project. Which action should have been used to meet this goal?
Establishing a goal to optimize patient recovery from illness
Despite professional counseling and a pledge not to consume alcohol, a patient receiving outpatient Antabuse treatment presents in the emergency department (ED) violently ill. During the interview, the patient said only a small amount of alcohol was used and that the Antabuse was being used as prescribed. Which factor is associated with the treatment currently in use?
Health literacy
A healthcare coordinator is contacted because a patient has been in the hospital for two weeks, and the medically necessary care goals have been met. The discharge has been ordered, but the patient is refusing to leave the hospital and complaining of being too sick to leave. · Which response will the hospital give in relation to this individual's continued inpatient care?
Hospital-issued notice of non-coverage (HINN)
A health services coordinator works with a healthcare team to research how to improve influenza immunization rates in an ambulatory setting. The team would like to analyze potential contributing factors in order to develop preventative strategies using an evidence-based practice (EBP) process. What is the initial step of this process?
Identify the immunization rates over the past five years
A new human resources director is developing a new diversity program for healthcare workers. The human resources director believes diversity is a solid pillar of good governance and leadership. What is one expected outcome of this type of program?
Improving the delivery of care
A patient had a stroke and was informed that it was due to a clot stemming from atrial fibrillation. The patient would like to undergo surgery immediately to address future clots. When asked about this preference, the patient explains that her neighbor had the same medical problem and that surgery had worked well. The healthcare coordinator is concerned that the patient is not fully aware of the associated risks and benefits of this option. Which type of preference in the shared decision-making model is being used by this patient?
Initial
Which intervention recommended by the coordinator will decrease hospital acquired infection rates?
Instruct the patient and family to wash their hands
A health services coordinator is assembling a clinical team to oversee long-term care plans for patients in a skilled nursing facility. Which team format meets this goal?
Interdisciplinary team
A health services coordinator is working with a patient on a discharge plan of care in a behavioral health setting. The coordinator uses motivational interviewing to engage the patient in shared decision-making about the discharge plan. What is a benefit of this approach?
It focuses on exploring and resolving ambivalence to change behavior.
A healthcare clinic is completing a self-study in preparation for an on-site visit. Which group should the clinic contact to have questions answered?
JCAHO
A health services coordinator works at a hospital and learns that a friend's mother was admitted to the same hospital. The coordinator tells his supervisor that he would like to work with that patient. The supervisor is concerned about this request in relation to a component of HIPAA/CFR 42. Which component is this supervisor concerned about?
Minimum necessary provision
Hospital officials are working to ensure all hospital staff apply diverse care methods. Which strategy should upper management use to meet this goal?
Model behaviors that communicate respect
A local rural health center has recently received funding to improve healthcare in a rural, diverse population. The center will focus mainly on chronic diseases and mental illnesses according to Healthy People 2020. Which entity is responsible for monitoring the progress of this initiative?
National Center for Health Statistic
A patient had a major surgery that left a very large wound to heal. At discharge, the patient complained that the pain was so unbearable that death would be preferable than continuing to live. Which type of care does the patient need?
Palliative
Patient adherence is an essential component of successful treatment plans. Which strategy can improve this situation?
Partner with the patient in the treatment plan
A care coordinator provided a large list of community resources to a patient seen for cirrhosis of the liver secondary to alcoholism. Each option is reviewed, and the patient's perception of barriers to accessing assistance are solicited. The coordinator follows up in a week to see how the patient is progressing. Which organizational mission objective is demonstrated by this coordinator's actions?
Patient-centered
A patient comes into the healthcare facility with acute chronic heart failure. His family states he has not taken his medication for three days because they were too expensive to obtain. Who should be part of the interdisciplinary team to help this patient and his family?
Pharmacy
A health services coordinator is working with a patient on a discharge plan from a rehabilitation center after suffering a stroke. The patient is physically ready for discharge but is still experiencing some difficulty in finding words to speak and expresses frustration. The coordinator is considering a family conference to discuss the discharge plan. Which action by the coordinator should be carried out?
Present the plan in small sections, allowing the patient to nod understanding or speak if able
A rural hospital is offering incentives for health services coordinators to participate in evidence-based practice (EBP) in-service training sessions. A large number of coordinators register for and attend the sessions. How will the high attendance benefit this hospital?
Promotes improved patient care
A health services coordinator recently joined an advanced pediatric care practice that deals with complex childhood diseases. The practice administrator would like the coordinator to focus on ways to improve shared decision-making that involves all parties, including the child when possible. Which approach meets this goal?
Provide information that includes options, risks, benefits, and research tailored to the child's level and parents' literacy needs
An interdisciplinary team is seeing problems with medication safety in older adults. The health services coordinator would like to identify strategies to prevent the negative impact on this population. What is an evidence-based practice that will have a positive impact on this patient population?
Provide medication-specific education using the teach-back method to the patient and caregiver
A health service coordinator is reviewing the chart of a hospitalized patient currently in the ICU. The patient is experiencing complications related to a surgery, and the patients hospital discharge will be delayed beyond the five days previously approved. Which action should be taken to receive approval?
Provide supporting clinical information to the insurance company
A health services coordinator wants to decrease infection rates associated with central venous catheter insertions in the operating room. A new procedure is written using evidence-based practice. Several precise, separate supplies were identified to encourage a sterile procedure, including a special antiseptic wash, dressings, and personal protective equipment. Which action should the coordinator take to effectively increase staff compliance?
Provide the supplies needed in one package in an accessible location
What is the purpose of a care plan?
Providers direction for continuity of care
A health services coordinator is part of an interdisciplinary primary care team reviewing effective treatment for asthma patients. The team has noticed that the patients who have asthma are not responding well to the traditionally prescribed treatment. The team is interested in exploring research to determine the efficacy of a new intervention to improve patient outcomes. Which type of study design will support this question?
Randomized controlled trial
An individual under the influence of drugs comes to an emergency room (ER) with a deep laceration to the hand. The patient is well known to the ER, and they have a long history of admissions with illicit drug abuse. The health services coordinator meets with the patient who agrees to an outreach program, and the coordinator begins discharge planning. Which component of SBIRT was used in this patient's case?
Referral to treatment
A transgender individual is seeking a bed in a homeless shelter, but the nearby location is male-only. This individual presents as male but is biologically female. The case management team discusses the options with the patient, and they decide to find a shelter that is co-ed. What is the reason behind this team's placement decision?
Safety
A patient diagnosed with breast cancer has been given brochures regarding treatment options. The next day, the healthcare provider and care coordinator each provide the patient with additional information regarding the various options. Which action by the team represents the second task of the shared decision-making model?
Supporting the patient while deliberating options and exploring the patient's reactions to the information
A small rural hospital lacks mental healthcare and wants to provide remote access for patients. How can the hospital provide this access?
Telehealth system
A patient living in a rural area with a diagnosis of congestive heart failure requires daily vital signs monitoring. Which form of technology should be used to remotely monitor this patient?
Telemedicine
A health services coordinator calls a patient's insurance company to confirm coverage for a wheelchair, home therapy, and any restrictions concerning prescription fulfillment. Why is this action by the coordinator necessary?
To follow managed care utilization practices
A billing manager and healthcare coordinator are discussing how money paid to the hospital for services delivered to Medicare and Medicaid patients is tied to penalties and incentives for achieving quality measures. Which Medicaid model is the billing manager referencing?
Value-based reimbursement
A hospital manager is conducting interviews for the entry-level, specialist electronic medical record (EMR) position. The manager is making a list of the knowledge and skills that will guide the selection of an ideal candidate. What is the minimum level of knowledge and skills the manager should require?
Willingness to learn basic technology and computer skills
A client has been treated in a behavioral health center for depression but has made steady improvements and is ready for discharge. The health services coordinator uses motivational interviewing to engage the client in shared decision-making about the discharge plan. Which statement by the coordinator is appropriate?
"Please identify some small goals that you feel you can accomplish."
An organization uses InterQual criteria. What is the purpose of this computer application?
Determining medical necessity
A health services coordinator is preparing to speak to a patient with Native American heritage about home care services. The patient has leg pain and is to be discharged with six weeks of intravenous antibiotics and dressing changes. The patient has previously sought treatment from a tribal medicine man instead of following physician's orders. Which question should the coordinator ask the patient in order to plan the patient's care?
Do you understand the home care treatment plan?
A health services coordinator at the local department of human resources has decided that the best way to help the consumers on caseload is to collaborate with the social workers and utilization managers. The coordinator, however, is unable to find any available utilization managers. Which case management model should be used?
Dyad
A healthcare team is managing a rare disease case. The team would like to analyze the current treatment to improve clinical practice. The evidence-based practice (EBP) question has been developed to guide the initiative. What is the next step of the EBP process?
Search for evidence related to the question
A healthcare provider perceives that a client was disrespectful and difficult to work with for the past few days. The healthcare provider decides to seek advice from a medical professional who is not involved in the case on the best way to deal with this client. Which protocol should be used for this purpose?
Seek advice without providing any identifiable information
A patient with dementia has been admitted to a long-term care facility. The family arrives with the patient and meets with the health services coordinator. The family expresses their concern that the multiple providers may not communicate well enough with one another and with them. Which approach is appropriate for this purpose?
Setting up regular team conferences with all clinicians and the family
Which principle of client engagement is being practiced when a health services coordinator and a patient watch a video together on weight loss?
Shared decision-making