GKA CCM Exam-Concepts 37 Questions with Verified Answers
Five Ethical Principles - CORRECT ANSWER autonomy, beneficence, nonmaleficence, justice, and
... [Show More] veracity
Autonomy - CORRECT ANSWER Empower.A form of personal liberty of action in which the patient holds the right and freedom to select and initiate his or her own treatment and course of action and to take control of his or her health (i.e. fostering the patient's independence and self-determination.)
Beneficence - CORRECT ANSWER Do good. The obligation and duty to promote good, to further and support a patient's legitimate interests and decisions, and to actively prevent or remove harm (i.e. to share with the patient the risks associated with a particular treatment option.)
Nonmaleficence - CORRECT ANSWER prevent harm or wrongful acts. Refraining from doing harm to others (i.e. emphasizing quality care outcomes), or if harm is inevitable, insuring that as little harm occurs as possible
Justice - CORRECT ANSWER Be fair. Maintaining what is right and fair, and making decisions that are good for the patient; balancing what is just for one's patient, versus what is just for the larger society
Veracity - CORRECT ANSWER Truthfulness. The act of telling the truth; the truthfulness of one's behavior. It is the obligation of the case manager to conform, in his/her dealings with patients and families, to fact or truth, to accuracy and precision.
Benchmarking - CORRECT ANSWER the comparison of an organization's practices and performance with the practices and performance of other organizations in order to identify best practices and standards to improve quality.
Root cause analysis (RCA): - CORRECT ANSWER a method of problem solving which identifies and addresses the root of a problem or issue so that the problem or issue is not recurrent.
Prospective review: - CORRECT ANSWER review for need for case management prior to start of services (i.e., preadmission review). 3-5% of cases reviewed prospectively are in need for case management. A prospective review helps to determine necessity and estimated length of stay.
Concurrent review: - CORRECT ANSWER review while services are being rendered; reviews the success or failure of treatments and provides data for reducing length of stay or exploring alternate care plans. It also documents the required processes for discharge success.
Retrospective review - CORRECT ANSWER reviews case outcomes after the patient's discharge; it tracks the appropriateness of care and consumption of resources, and allows the case manager to take away information which will assist with planning future, similar cases.
Risk management - CORRECT ANSWER the "clinical and administrative activities undertaken to identify, evaluate, and reduce the risk of injury to patients, staff, and visitors and the risk of loss to the organization itself." (Joint Commission). Risk management can be proactive (avoiding/preventing risk) or reactive (minimizing loss or damage after an adverse/bad event).
Case management - CORRECT ANSWER is 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, communication, and resource management and promotes quality and cost-effective interventions and outcomes.
Managed care - CORRECT ANSWER is a health care system with administrative control over primary health care services in a medical group practice. The intention is to eliminate redundant facilities and services and to reduce costs. The term is used to describe many types of medical care plans including, HMO, PPO, IPA, etc.
Disease management - CORRECT ANSWER focuses on groups of patients with diagnostic conditions that historically
have high financial costs and will benefit from integrated and systematic
management of treatment. The goal of disease management is to reach individuals at the earliest possible time in the disease cycle.
Catastrophic case management - CORRECT ANSWER oversees patients with or at risk for extremely high healthcare costs (i.e., individuals with AIDs, premature infants, transplant patients, end-stage renal disease/dialysis, and spinal cord injuries)
Catastrophic disease management - CORRECT ANSWER focuses on groups of patients and populations with or at risk for extremely high healthcare costs conditions that historically
have high financial costs and will benefit from integrated and systematic
management of treatment. Heart failure, high-risk pregnancy, diabetes with complications, and CAD with complications are some examples of conditions that may be managed by catastrophic disease managers.
Brokerage case management - CORRECT ANSWER is a very brief approach to case management in which case workers attempt to help clients identify their needs and broker ancillary or supportive services, all in one or two contacts.
Strengths case management - CORRECT ANSWER focuses on clients' strengths, self-direction, and the use of informal help networks rather than on agency resources; it further stresses the primacy of the client-case manager relationship and applies an active form of outreach.
Transition of Care process - CORRECT ANSWER This is the process case managers apply to ensure that appropriate resources and services are provided to patients and that these services are provided in the most appropriate setting or level of care as delineated in the standards and guidelines of regulatory and accreditation agencies. It focuses on moving a patient from a highly complex to a less complex care setting.
Sentinel Event - CORRECT ANSWER is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. These events signal the need for immediate investigation and response. Serious injury specifically includes loss of limb or function; the phrase "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Root cause Analysis is a basic tool.
SF-36 - CORRECT ANSWER is a health survey used by some case managers; it is a multi-purpose, short-form health survey with only 36 questions. It yields an 8-scale profile of functional health and wellbeing scores as well as psychometrically-based physical and mental health summary measures and a preference-based health utility index.
Eight Essential Activities of Case Management - CORRECT ANSWER Assessment, Planning, Implementation, Coordination, Monitoring, Evaluation, Outcomes, General
PLANNING - CORRECT ANSWER SETTING GOALs, The process of determining and documenting specific objectives, goals, and actions designed to meet the client's needs as identified through the assessment process. The plan should be action-oriented and time specific
IMPLEMENTATION - CORRECT ANSWER EXECUTING-The process of executing and documenting specific case management activities and/or interventions that will lead to accomplishing the goals set forth in the case management plan
COORDINATION - CORRECT ANSWER LIAISON-The process of organizing, securing, integrating, modifying, and documenting the resources necessary to accomplish the goals set forth in the case management plan
MONITORING - CORRECT ANSWER ONGOING PROCESS,The ongoing process of gathering sufficient information from all relevant sources and its documentation regarding the case management plan and its activities and/or services to enable the case manager to determine the plan's effectiveness
EVALUATION - CORRECT ANSWER EFFECTIVENESS,The process repeated at appropriate intervals, of determining and documenting the case management plan's effectiveness in reaching desired outcomes and goals. This might lead to a modification or change in the case management plan in its entirety or in any of its component parts
Best Alternative to a Negotiated Agreement (BATNA) - CORRECT ANSWER trust
respect other parties
avoidance of irritates
active listening
Standards of Practice - CORRECT ANSWER Authoritative statements addressing the foundational knowledge and skills of a nurse case manager's actions are:
Performance Improvement - CORRECT ANSWER Managing clinical outcomes, studying variance trends, and evaluating actions taken to correct deviations from critical pathways
NCQA - CORRECT ANSWER NCQA oversees managed care.
Ethics - CORRECT ANSWER refers to the rules or standards that govern the conduct of a person or members of a profession. Ethical rules describe a society's ideal of how a person or professional should conduct himself or herself.
Assessment - CORRECT ANSWER collecting info
cultural competence - CORRECT ANSWER is "the ability of healthcare providers to deliver services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients"
DSM-IV - CORRECT ANSWER • DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability.
• Axis I: Clinical disorders, including major mental disorders and learning disorders
• Axis II: Personality disorders and intellectual disabilities
• Axis III: Acute medical conditions and physical disorders
• Axis IV: Psychosocial and environmental factors contributing to the disorder
• Axis V: Global Assessment of Functioning or Children's Global Assessment Scale from 0-100 (O the worst) (for individuals under the age of 18)
irritator - CORRECT ANSWER Any characterization by one party of the other party's facts, positions, or issues that implies a negative judgment, such as "That's an insulting offer!" or "We've been more than generous!" or "We've been nothing, if not cooperative." [Show Less]