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
A care manager is using a risk stratification tool to prioritize a caseload. Which patient would typically receive the most intensive care management?
Answer: A 70-year-old with three chronic conditions, recent hospitalization, and low health literacy
Patients with multiple chronic conditions, recent acute care utilization, and social risk factors like low health literacy are at highest risk and benefit most from intensive care management.
The Coleman Care Transitions Intervention focuses primarily on developing the patient's:
Answer: Self-management skills and self-advocacy during care transitions
The Coleman model coaches patients to become active participants in their own care during transitions, using four pillars: medication self-management, dynamic patient record, follow-up scheduling, and red flag recognition.
A patient with congestive heart failure (CHF) calls reporting a 5-pound weight gain in two days. The care manager's most appropriate immediate action is:
Answer: Triage the symptom and facilitate urgent contact with the patient's cardiologist or PCP
Rapid weight gain in CHF indicates fluid retention and possible decompensation, requiring urgent clinical assessment; the care manager facilitates timely provider contact rather than self-prescribing or defaulting to the ED.
Which element is essential to include in a culturally competent care plan?
Answer: Patient's cultural beliefs, preferences, and health practices that may affect care
Culturally competent care requires incorporating the patient's cultural beliefs and practices into the plan to ensure it is acceptable, feasible, and effective for that individual.
What is the primary purpose of an Individualized Care Plan (ICP) in care management?
Answer: To outline personalized goals, interventions, and timelines based on patient needs
An ICP is a patient-centered document that translates assessment findings into actionable, time-bound goals and interventions tailored to the individual's needs and preferences.
A care manager notices signs of elder abuse during a home visit. Which is the most critical immediate step?
Answer: Consult with the supervising care manager and file a mandatory report with Adult Protective Services
Care managers are mandatory reporters in most jurisdictions; suspected elder abuse must be reported promptly to Adult Protective Services to ensure patient safety.
In care management, 'motivational interviewing' (MI) is best used to:
Answer: Elicit the patient's own motivation for behavior change through guided conversation
MI is a patient-centered counseling technique that draws out the patient's intrinsic motivations for change rather than imposing the provider's agenda.