Case Management Process Practice Questions from courses
One factor that affects the choice of format for a case management plan is: a. Patient complications b. Existing standards for regulatory agencies c. The population served d. Diagnosis related groups
B (Feedback: Survival Guide, p. 233)
Algorithms are best described as: a. Problem-based procedures that are developed by health care providers as consensus statements to delineate the processes of caring for a patient with a specific medical condition. They include a step-by-step guide to care and typically focus on the clinical decision-making process. Typically, they are written in an "if...then" format that is systematic, stepwise, chronological, and outcomes-driven. b. Preprinted order sets that are prospectively prepared to delineate a standardized process for patient care based on research outcomes and the latest recommendations of professional organizations. c. Narratives or outlines that rely on expert opinions, consensus statements, and research outcomes. They refer to specific timeframes in appropriate patient care and tend to be based on nationally acceptable levels of care. d. none of the above
A
Case managers facilitate and coordinate the work of the health care team in an effort to promote all of the following EXCEPT: a. Handoff to the next care setting as quickly as possible b. cost-effectiveness c. safety d. efficient care
A
Continuum of care is defined as: "...a linkage of ____________ across health care delivery settings and sites of care." a. Health services b. Cradle to grave services c. Preventive and tertiary services d. Physicians
A
One example of post discharge services that may be coordinated by a transitional plan is: a. Durable medical equipment purchased b. Family assignments for care c. Authorization for services referred to the MCO d. Education needs are met by the case manager
A
Outcome indicators which mandate the patient's discharge from one level of complexity to the next most appropriate level are: a. Discharge criteria b. Rehabilitation options c. Quality evaluation d. Continuum of care standards
A
Practice setting refers to: a. The care setting where a case manager is employed to execute his/her responsibilities b. The training program used by a case manager employer to train in case management skills c. Both A and B d. None of the above
A
Step 1 in the case management process is: a. Client identification b. Utilization review c. Monitoring d. Assessment
A
The case management process focuses upon: a. Catastrophic cases b. Control of diagnostic testing c. The health care team's ability to meet goals d. Needs of the patient only
A
The need for coordination across boundaries is increased due to: a. Multiple and complex elements of chronic illness management and decreased hospital inpatient stays b. Complex regulations and reimbursement programs that patients cannot understand and navigate alone c. Health care reform measures that mandate greater nursing responsibility for care coordination d. All of the above
A
Through the case management process, case managers eliminate: a. Fragmentation in care delivery b. Long-term care planning c. Use of community resources d. Use of specialists for common care
A
Transitional planning, as a terminology, reflects: a. The way managed care reimbursement functions b. The case management profession c. The focus on fee for service d. Physicians are the sole decision makers
A
One outcome of hospital case manager/physician partnership is: a. Physician relief from business transactions b. Collaboration for treatment c. Physician economic decrease d. Decreased use of acute care
A (Feedback: Core Curriculum, p. 79)
A practice setting for case management is: a. A care setting in which responsibilities can be executed b. A care setting with a physician team leader c. A care setting which reviews provider contracts d. A care setting which conducts research only
A (Feedback: Core Curriculum, p. 43)
A triad model of collaborative case management includes the nurse case manager, social worker and UR specialist, resulting in: a. Outcome management b. Care mapping c. Statistical equality d. Statistics management
A (Feedback: Nursing Case Management, p. 80)
A transitional plan must focus upon a patient's areas of deficits to: a. Establish goals of the plan b. Retain the patient on an inpatient basis c. Involve the family in service provisions d. Direct community resources
A (Feedback: Survival Guide, p. 126)
The documentation method used as an integral part of clinical trials and research is a: a. Protocol b. Patient's record c. Clinical pathway d. Algorithm
A (Feedback: Survival Guide, p. 223)
Define case management:
A collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human service needs. It is characterized by advocacy, communications, and resource management and promotes quality and cost-effective interventions and outcomes.
Four major areas of activity for insurance-based case managers are all of the following EXCEPT: a. Medical activities b. Financial activities c. Behavioral/motivational activities d. Claims processing activities e. Vocational activities
D
A facility which meets specific regulatory requirements that provides inpatient care and related services but does not provide the level of care found in a hospital is: a. Custodial care b. Skilled nursing facility c. Assisted living d. Respite care
B (Feedback: Core Curriculum, p. 117)
Name the eight case management activities:
Assessment Planning Implementation Coordination Monitoring Evaluation Outcomes General A PIC ME Out Girl
An interdisciplinary practice that focuses on the coordination of care activities and the allocation of resources required by a patient is: a. Resource management b.Case management c. Outcome management d. Utilization review
B (Feedback: Core Curriculum, p. 178)
Case managers in the telephonic practice setting engage in: a. Defining a comprehensive action plan b. Identifying patient's health risks c. Focusing upon treatment of an acute episode d. Focusing upon community-based care
B (Feedback: Core Curriculum, p. 47)
Medicare and Medicaid reimbursement rates are driven by: a. Matching codes b. Federal guidelines c. JCAHO d. State designation
B (Feedback: Survival Guide, p. 118)
One driving force stimulating the use of case management plans is: a. Utilization review b. The prospective payment system c. Decrease in litigation d. Certification for case managers
B (Feedback: Survival Guide, p. 217)
A dynamic, interactive, collaborative and interdisciplinary process of assessment and evaluation of healthcare needs of patients and families after an episode of illness is: a. Continuum of care b. Transitional planning c. Accreditation review d. Managed care
B
A strategy for quality of care improvement is: a. Multidisciplinary action plans b. Practice guidelines c. Risk management d. Clinical pathways
B
Acute services are those provided during an acute episode of illness and are provided in: a. A health care screening center b. A hospital setting c. An ambulatory care setting d. An assisted living facility
B
Case management that is "within the walls" refers to: a. Services provided inside of home health agencies b. Services provided inside of acute care or hospital settings c. Services provided inside of an insurance company d. All of the above
B
Case managers facilitate the work of the team to promote: a. Rapid patient discharge b. Cost effective, safe and efficient care c. Use of non-hospital based care d. Use of the HMO services
B
Case managers in the insurance companies are sometimes called the "claims police" because they ensure cost-effective treatment plan. True False
B
Hospital based case managers have goals of quality care and expedient transfer to other levels of care. True False
B
One goal of the transitional planning process is: a. Influencing physician orders for care b. Providing linkages among varied providers c. Ensuring quality of care in the acute setting only d. Ensuring patient/family adherence to regulatory agencies
B
Patient and family case management plans are used primarily to facilitate __________. a. nationwide standardization of patient care in university-based teaching hospitals b. communication and education regarding realistic expectations of future care and treatment c. tracking of hospital admissions, length of stay, and discharge data regarding patients in specific diagnosis-related groups d. nationwide standardization of patient care in private, non-university-based teaching hospitals
B
The continuum of care is: a. A linear course of care settings that patients use in the course of treatment b. A non-linear group of care settings that patients can use in any sequence c. A non-linear group of care settings that follow a logical course based on insurance coverage d. A linear course of care settings that start with acute care and end with home
B
What type of case management plan is described below? This is a detailed plan with allowances for documentation and medical orders. It demonstrates evidence of a collaborative approach to care. The plan specifies the necessary interventions and the related and expected outcomes in relation to the patient's progression toward recovery. Because they are outlined prospectively, sequences of events, specific timeframes, and patient outcomes are identified. This specificity lets practitioners easily evaluate the patient's condition and determine the next appropriate step in her or his care. a. Clinical/critical pathways b. Multidisciplinary action plan c. Algorithm d. Issue-specific recommendation
B
Working together with the patient/family, care providers and others to achieve consensus on goals and maximize outcomes is: a. Coordination b. Collaboration c. Advocacy d. Implementation
B
A type of care that provides caregiver support by time away from the patient is: a. Assisted living b. Respite care c. Supported living d. Custodial care
B (Feedback: Core Curriculum, p. 135)
The patient's condition at the time he or she exits a health care setting is: a. Outcome b. Output c. Patient flow d. Input
B (Feedback: Core Curriculum, p. 43)
All the following are focuses when developing and implementing case management plans except __________. a. innovating and developing new practices b. ensuring consistency and continuity of care c. developing and implementing national standards of care to be applied to all diagnosis-related groups, where appropriate for the individual patient d. modifying current methods by integrating the outcomes of research and clinical trials
C
Healthcare organizations can no longer afford to keep patients at one level of care due to: a. Utilization management b. Brokering of care c. The risk of loosing reimbursement d. Certification criteria
C
If a patient and family disagree with a discharge, they are entitled to an appeal by notifying: a. Hospital administration b. JCAHO c. The peer review organization d. Milliman and Robertson
C
Independent or private case managers are also known as: a. Impartial advocates b. Comprehensive, long-term managers c. External case managers d. Chronic care managers
C
Problem-based procedures of care that are developed as consensus statements to delineate processes for caring for an individual with a specific health problem are known as: a. Protocols b. Clinical guidelines c. Algorithms d. Procedure books
C
Some common case management problems affecting continuity of care that are associated with transferring a patient from one care setting to another are: a. Timeliness of the transportation service and finalizing discharge orders b. Waiting for openings at the chosen program and getting transfer evaluations completed c. Finding an appropriate care setting in the desired geographic area and ensuring that adequate information is transferred between the care settings d. All of the above
C
Termination of case management services happens automatically and the patient does not need to be notified: a. True, all care associated with the hospitalization is known to end at discharge b. True, the criteria for ending case management was told to the patient when services were initiated c. False, patients must be given notice and an explanation at the time that case management ends d. False, patients need to opportunity to appeal for continuance of case management services
C
Which of the following can lead to an unsafe discharge: a. Collaboration b. Comprehensive psychosocial review c. A poor assessment d. Identification of actual and potential problems
C
Which of the following is NOT a type of case management plan? a. Algorithms and protocols b. Guidelines and critical pathways c. Procedure manuals and standing orders d. Preprinted order sets and issue-specific recommendations
C
A legal document that directs whom the health care provider should contact for consent for treatment decisions when the patient can no longer decide for himself/herself is a/an: a. Will b. End of life care c. Health care proxy d. Patient self-determination
C (Feedback: Core Curriculum, p. 144)
Tools for educating the consumers of health care are: a. ICD9 codes b. Protocols c. Case management plans d. CPT codes
C (Feedback: Survival Guide, p. 242)
The term used to identify the effective use of case management interventions and the impact of case management on care is: a. Implementation b. Coordination c. Outcomes d. Monitoring
C (Feedback: Core Curriculum, p. 181)
The intensity of services necessary to diagnose, treat, preserve or maintain an individual's health and functioning is: a. Level of service b. Practice setting c. Level of care d. Throughput
C (Feedback: Core Curriculum, p. 43)
The methods, procedures, styles and techniques rendered to deliver health care services are the: a. Structure b. Patient flow c. Process d. Throughput
C (Feedback: Core Curriculum, p. 44)
A process that facilitates appropriate and informed decision making and includes client values, beliefs and interests is: a. Autonomy b. Beneficence c. Advocacy d. Justice
C (Feedback: Core Curriculum, p. 75)
The tool used by providers for risk management purposes is: a. Case management plans b. Length of stay c. Practice guidelines d. Multidisciplinary action plans
C (Feedback: Survival Guide, p. 218)
Acting on behalf of those who cannot speak for or represent themselves is known as: a. Intervention b. Monitoring c. Collaboration d. Advocacy
D
Case management plans are ____________ developed as statements, guidelines, and strategies for patient care management. a. loosely b. independently c. retrospectively d. systematically
D
Case management plans are one way to deliver: a. Increased filtration of managed care b. A continuum of care c. More rapid reimbursement d. Best practice care
D
Case managers in hospice care: a. May be called the Coordinator of Care (COC) b. Perform utilization management practices c. Endeavor to reduce emergency care through symptom control d. All of the above
D
Case managers need to know all of the following except: a. Criteria for patient admission b. Services available within a care setting c. The goals that a patient needs to achieve d. Licensing regulations that created the continuum of care
D
Community-based case managers in home health agencies have all of the following purposes EXCEPT: a. Care planning b. Continuity of care c. Follow-up care d. Expedient transition to outpatient services
D
If the interdisciplinary case management plan development team finds no consistency in treatment when reviewing the practice patterns of providers and a sample of patient medical records, _________________. a. no further planning is attempted, and the institution instead adopts the plan of a nearby facility b. the team reviews the records and practice patterns of nearby facilities c. no further planning is attempted until additional patients are treated and a consistent pattern is established d. the team reviews and evaluates the related literature
D
Measuring the effectiveness of case management interventions to determine the clinical impact of case management is called: a. Monitoring b. Planning c. Problem identification d. Outcomes
D
Services offered to prevent illness or deterioration or a patient's condition is known as: a. Patient care eligibility b. Health maintenance services c. Long-term health services d. Pre-acute services
D
he continuum of care can be aggregated into: a. Pre-illness, acute care, rehabilitation, discharge b. Health stability, disease state, wellness c. Aging, elder care, end of life care d. Pre-acute, acute and post-acute care and services
D
Case management practice is dependent upon which of the following factors? a. Patient choice b. Provider contract for services c. Geographical location d. The reimbursement method
D (Feedback: Core Curriculum, p. 44)
Case management services are considered intensive and comprehensive in the: a. Telephonic phase b. Continuum of care c. Post acute setting d. Acute care setting
D (Feedback: Core Curriculum, p. 45)
In the preacute setting, case management focuses upon the: a. Family as a support b. High costs of services c. Onsite assessment d. Least complex of services
D (Feedback: Core Curriculum, p. 45)
One component of developing a case management plan policy/guideline is: a. To identify methods to exclude the family b. To create a glossary of terms c. To isolate outcomes d. To identify the steps followed by the team
D (Feedback: Survival Guide, p. 247)
Any expected outcome that has not been achieved within a specific time frame is known as a/an: a. Underutilization b. Team consensus c. Risk d. Variance
D (Feedback: Survival Guide, p. 418)
The continuum of care contains which of the following care settings: a. Health promotion and illness prevention b. Primary care and ambulatory care c. Rehabilitative care and long-term care d. Home care and palliative care e. All of the above
E
Once the case manager has determined an appropriate care setting, the case manager can confidently choose any provider of that setting type. True False
False
The most important priority in selecting a new care setting is making sure insurance authorization is obtained. True False
False
A case manager in acute rehabilitation has tasks related to clinical decisions and team management. True False
True
It is important to know the goals that can be achieved at any care setting True False
True
The need for barrier reduction in inter-organizational communication is an urgent need for continuity of care. True False
True
Case managers in long-term care settings must possess specialized knowledge related to the population served, including clinical treatment and insurance issues. True False
true