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Exam #1_ Case Management.pdf, Exams of Nursing

Walden UniversityNursing

Exam #1_ Case Management.pdf Graded A+

Typology: Exams

2024/2025

Available from 08/11/2025

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jane-harun 🇺🇸

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Exam #1: Case Management
What is a case manager accountable for? -
The case manager is accountable for collaboratively facilitating the assessment, planning,
implementation and evaluation of care coordination and care transitions in the acute care setting.
What are case managers advocates for? -
Nurse case managers serve as advocates for options and services to meet the patient and family
needs, while promoting quality, cost effective outcomes for the assigned case types.
What are 5 key functions and responsibilities of a case manager? -
1. Coordination and facilitation of care
2. Utilization and resource management
3. Tracking of avoidable delays
4. Transitional and discharge planning
5. Quality and process improvement
A nurse case manager must encompass a knowledge of the health care environment with regards to
what 4 aspects? -
1. Clinical
2. Business/Financial
3. Managerial
4. Professionalism
In the clinical setting, what type of assessment does the case manager perform? -
Patient and family interview and review of medical record
What type of planning is performed by the case manager in a clinical setting? -
Consult with the physician, health care team and patient/family - develop plan of care to facilitate a
timely discharge /transition plan
What type of implementation is performed by the case manager in the clinical setting? -
Implements the plan of care in a timely manner to facilitate accomplishment of goals and
interventions.
What type of evaluations do case managers perform in the clinical setting? -
Reassessment for any decline in status and plan revisions
What are 4 roles of the case manager in managing business/financial concerns? -
1. Ensure that the level of care is appropriate and services are medically necessary
2. Proactively identify delays in care, delays in discharge and risk of readmission
3. Maintain competence of utilization review (inpatient vs. observation status)
4. Document avoidable delays/days
What are 5 managerial duties of the case manager? -
1. A nurse case manager must display leadership skills in decision making and problem solving
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Exam #1: Case Management

What is a case manager accountable for? - The case manager is accountable for collaboratively facilitating the assessment, planning, implementation and evaluation of care coordination and care transitions in the acute care setting. What are case managers advocates for? - Nurse case managers serve as advocates for options and services to meet the patient and family needs, while promoting quality, cost effective outcomes for the assigned case types. What are 5 key functions and responsibilities of a case manager? -

  1. Coordination and facilitation of care
  2. Utilization and resource management
  3. Tracking of avoidable delays
  4. Transitional and discharge planning
  5. Quality and process improvement A nurse case manager must encompass a knowledge of the health care environment with regards to what 4 aspects? -
  6. Clinical
  7. Business/Financial
  8. Managerial
  9. Professionalism In the clinical setting, what type of assessment does the case manager perform? - Patient and family interview and review of medical record What type of planning is performed by the case manager in a clinical setting? - Consult with the physician, health care team and patient/family - develop plan of care to facilitate a timely discharge /transition plan What type of implementation is performed by the case manager in the clinical setting? - Implements the plan of care in a timely manner to facilitate accomplishment of goals and interventions. What type of evaluations do case managers perform in the clinical setting? - Reassessment for any decline in status and plan revisions What are 4 roles of the case manager in managing business/financial concerns? -
  10. Ensure that the level of care is appropriate and services are medically necessary
  11. Proactively identify delays in care, delays in discharge and risk of readmission
  12. Maintain competence of utilization review (inpatient vs. observation status)
  13. Document avoidable delays/days What are 5 managerial duties of the case manager? -
  14. A nurse case manager must display leadership skills in decision making and problem solving
  1. Must actively participate in Interdisciplinary Team Meetings and maintain open communication with physicians
  2. Strive to make productive use of time through the setting of priorities
  3. Foster an environment of professionalism
  4. Utilize the Chain of Command effectively in addressing complex/unusual situations What are 5 key points that the case manager is responsible for in instituting professionalism in the profession? -
    1. Integrate high ethical standards and core values
  5. Hold self and others accountable
  6. Perform work in an accurate and timely manner
  7. Serve as a role model and mentor
  8. Maintain current clinical knowledge and leadership skills What is a clinical pathway? - A clinical pathway is a map of clinical practice for a particular diagnosis - also known as care maps. It is a timeline for patient care activities which is used by all disciplines What are clinical pathways used to achieve? - Clinical pathways have emerged as a popular method to standardize care while reducing costs and improving quality of care What term has Cone Health renamed their clinical pathways and why? - Cone Health has renamed them to "Patient Care Plan" in an attempt to make them more individualized What are 3 advantages of clinical pathways? -
    1. Enhances interdisciplinary collaboration
  9. Helps to reduce unnecessary variations in patient care and outcomes, improving quality
  10. A tool to incorporate local and national guidelines into everyday practices How are clinical pathways used? (3) -
    1. Permanent part of medical record
  11. Used in lieu of Care Plan and Orders
  12. The nurse in charge and the attending physician will select the appropriate on admission How are clinical pathways used in the case management process? (2) -
    1. Clinical pathways help case managers appropriately manage a patient's care related to the admitting diagnosis
  13. CP help to improve quality, decrease cost, manage length of stay and avoid delays in care In what settings are we now finding case management now that it has moved past the acute care setting? (5) -
    1. Home health agencies
  14. Physician practices
  15. Medical respite programs
  16. Faith based programs
  17. Independent case management consulting firms

What are preacute services? - Services that are offered to prevent illness or deterioration/changes in the patient's health condition that may require acute care or hospitalization What are some examples of preacute services? (6) -

  1. Health Risk Assessment ( cholesterol and blood pressure/hypertension screenings, mammography, prostate screening, risk assessment questionnaires focusing on degree of healthy lifestyle)
  2. Patient and family education materials for wellness
  3. Health promotion and illness prevention
  4. Health advice lines
  5. Triage services
  6. Counseling What are some settings for preacute services? (4) -
  7. Managed Care Organizations
  8. Ambulatory/clinics
  9. Physician offices or group practices
  10. Community-based health centers What are acute services? - Those that are provided during an acute episode of illness and in a hospital setting. What are some examples of acute services? -
  11. Emergency and trauma care
  12. Procedures such as a coronary artery bypass graft What are settings for acute services? (5) -
  13. Hospitals
  14. Acute rehabilitation facilities
  15. Postanesthesia units
  16. ICU's
  17. ED's What are post-acute services? - Services that are provided for patients after an acute episode of care, whether in a facility setting or at home Why are case managers so imperative in periods of transition? - They are often the link that provides consistency for our patients What types of components must be included for an infrastructure to exist that keeps the patient- centered care a priority over care providers or care settings? (9) -
  18. Integrated medical records
  19. Integrated IT solutions
  20. Telehealth services
  21. Preventative care
  22. Chronic disease management
  23. High-risk community-based case management
  1. Transitional care coordination
  2. Case management
  3. Extended accessability What are Accountable care organizations (ACO's)? - They are organizations designed to provide an infrastructure for patient-centered care What is integrated care? - It is a concept bringing together inputs, delivery, management, and organization of services related to diagnosis, treatment, care, rehabilitation, and health promotion What is integrated care used for? - It is a means to improve services in terms of access, quality, user satisfaction, and efficiency What is integrated care often referred to as, and why? - Interdisciplinary health care, it is an approach characterized by a high degree of collaboration and communication among health professionals What makes integrated health care unique? - The sharing of information among team members related to patient care and the establishment of a comprehensive treatment plan to address the biological, psychological, and social needs of the patient What are the benefits of integrated health care? (5) -
    1. Effective in reducing readmissions and unnecessary admissions
  4. Can enhance access to services
  5. Improve quality of care
  6. Lower overall healthcare costs across the continuum
  7. Includes patients' behavioral health and psychosocial needs through integrating psychologists and other mental health providers What are the seven steps of phases of transitional planning? -
    1. Assessment of the patient's condition, risks, and needs
  8. Development of the discharge/transitional plan, including goals of treatment and disposition
  9. Implementation of the plan
  10. Evaluation, ongoing monitoring, and modification of the plan as warranted
  11. Confirmation of and final preparation for the patient's discharge or transition
  12. Discharge or transition of the patient to another level of care or to home
  13. Follow-up communication with patient post-discharge Who must be included in the transitional planning process? - Both the sender of the patient as well as the receiver of the patient What is the Transitions of Care Models Care Transitions Intervention (CTI)? - A four-week program designed to foster patient engagement and promote safe transitions from the hospital of skilled nursing facility to home What is an advantage of the Transitions of Care Models Care Transitions Intervention (CTI)? - Decreases rehospitalizations

Patient engagement, goal-setting, and communication with patient, family, and members of healthcare team. What is the focus of the Better Outcomes for Older Adults through Safe Transitions (BOOST)? - Focuses on hospital discharge process and communication with patients and receiving providers What is the advantage of the BOOST model of transitional planning? - Enhances quality of transitions and offers tools for the standardization of transitional care What are the 8 P's for risk assessment in the BOOST model? -

  1. Polypharmacy
  2. Psychological comorbidities
  3. Principal diagnosis of cancer, stroke, diabetes, COPD, or heart failure
  4. Physical function limitations
  5. Poor health literacy
  6. Poor social support system
  7. Prior hospitalization in the 6 moths before index period
  8. Palliative care needs What does the BOOST model involve? -
  9. Discharge planning
  10. Medication reconciliation
  11. Patient and Family Communication
  12. Discharge instructions
  13. Communication with patient's PCP before discharge What does the BOOST model also facilitate for the patient? - Scheduling of the patient's follow-up care appointment and includes post-discharge telephone call to patient In the BOOST model, what method is used in patient education and discharge instructions? - Uses the teach-back method What is the purpose of the Project RED (Re-Engineered Discharge)m model of transitional planning? - Improves hospital discharge process, promotes patient safety, reduces hospitalizations, and enhances patient's experience with care What are the 11 interventions of the Project RED model of transitional planning? -
  14. Language assistance
  15. Scheduling Appointments for follow-up care and testing
  16. Follow-up on pending test-results post-discharge
  17. Organization of post-discharge services and equipment
  18. Medication education and planning to ensure access to medications
  19. Development of Discharge plans based on national guidelines
  20. Patient understanding of discharge plan
  21. Patient education regarding diagnosis
  22. What to do in care of post-discharge problems
  23. Sharing of discharge summary of care with providers following up on the patient
  24. Post discharge telephone follow-up on patient

What is the Interventions to Reduce Acute Care Transfers (INTERACT) model of transitional planning? - Improves care in the long-term care setting (LTC's), skilled nursing facilites (SNF's), and assistes living facilites (ALF's) What is the goal of the INTERACT model of transitional planning? - To reduce preventable hospital readmissions What are the three main strategies implemented in the INTERACT transitional planning model? -

  1. Includes a number of quality improvement strategies for management of changing patient's conditions in these settings
  2. Offers tools to help healthcare professionals document, communicate, and institute early interventions to avoid worsening of patient's conditon and hospitalizations
  3. Enhances communication among providers in the LTC's, SNF's, ALF's, and hospitals What are clinical pathways? - Interprofessional care plans that outline the care and desired outcomes for a specific time period for patients with a specific diagnosis What is a negative variance? - Occurs when specific goals from clinical pathways are not met What are clinical pathways also known as? - Clinical maps What are common components of clinical pathways? (6) -
  4. Assessment guidelines
  5. Laboratory and diagnostic teaching
  6. Medications
  7. Activity
  8. Diet
  9. Teaching What do clinical pathways often describe in acute care? - Which patient care components are needed at specific times What are the case types that are usually selected for acute care clinical pathways? - Those that are high volume or high risk and predictable, such as MI and surgical procedures (e.g. endoscopy, cholecystectomy, cataract surgery)