Care Coordination & Patient Advocacy Flashcards
7 cards from real CCM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Care Coordination & Patient Advocacy flashcards as text
The primary goal of post-acute care follow-up within 7 days of hospital discharge is to:
Answer: Reduce the risk of preventable 30-day readmissions
Early post-discharge follow-up is a key evidence-based intervention to identify and resolve issues that lead to preventable 30-day hospital readmissions.
Social determinants of health (SDOH) screening in care management is primarily intended to:
Answer: Identify non-clinical barriers that affect health outcomes
SDOH screening identifies factors like housing instability, food insecurity, and transportation barriers that directly impact a patient's ability to follow their care plan.
A care manager working with a terminally ill patient who wants to remain at home should prioritize referral to:
Answer: Home hospice services
Home hospice services align with the patient's goal of remaining at home while providing comfort-focused care, symptom management, and family support.
Under HIPAA, a care manager may share a patient's protected health information (PHI) with a family member without written authorization when:
Answer: The patient is present and verbally agrees to the disclosure
HIPAA permits disclosure to family members when the patient is present, has capacity, and verbally agrees or does not object to the sharing of information.
Which intervention is most effective in improving medication adherence in patients with multiple chronic conditions?
Answer: Simplifying the medication regimen and providing pill organizers
Regimen simplification and practical tools like pill organizers directly address the cognitive and logistical barriers that most commonly cause non-adherence in complex patients.
A care manager identifies that a patient has been seeing three different physicians who are all prescribing opioids. The care manager's first responsibility is to:
Answer: Consult the state prescription drug monitoring program (PDMP) and discuss findings with the primary provider
Consulting the PDMP and coordinating with the primary provider is the appropriate clinical and advocacy-based response that addresses patient safety without prematurely judging the patient.
In the context of care coordination, 'care fragmentation' refers to:
Answer: A patient receiving care from providers who do not communicate or share information
Care fragmentation occurs when multiple providers deliver services in isolation, leading to duplicated tests, conflicting instructions, and increased risk of adverse events.