- Certified Case Manager Care Transition Management Questions and Answers Flashcards

Which evidence-based model focuses specifically on reducing hospital readmissions through enhanced transition planning?

Answer: The Care Transitions Intervention (CTI) by Eric Coleman

Eric Coleman's Care Transitions Intervention is specifically designed to reduce rehospitalizations through patient empowerment.

What is the recommended timeframe for scheduling a primary care follow-up appointment after hospital discharge for high-risk patients?

Answer: Within 48-72 hours

High-risk patients should have primary care follow-up within 48-72 hours of discharge.

During a care transition, which factor is the strongest predictor of a client's risk for readmission?

Answer: Having a previous hospitalization within the past 30 days

A recent hospitalization within 30 days is one of the strongest predictors of readmission risk.

What is the primary purpose of the teach-back method during discharge education?

Answer: To confirm the client's understanding of discharge instructions by having them explain it back

Teach-back confirms patient comprehension by having them explain instructions in their own words.

Which transition barrier is most commonly overlooked but significantly impacts medication adherence post-discharge?

Answer: Cost and insurance coverage of prescribed medications

Medication cost and coverage gaps are frequently overlooked during discharge planning.

What distinguishes a care transition from a care transfer in case management terminology?

Answer: A transition involves a change in health status or care needs while a transfer is a physical relocation between settings

A care transition encompasses changes in health status or care needs, while a transfer refers to physical movement between settings.