Care Management Concepts Flashcards
Data collection, analyzing and reporting, quality evaluation, access to timely and necessary services application, closing of relationship, reporting case termination to stakeholders and education regarding illness prevention is part of what case management domain?
Evaluation and Case Closure
Serving as a patient and family advocate falls under what case management domain?
Provision of services
Management of reimbursement appeals and denials falls under what case management domain?
Utilization Management
Assessing patients support network falls under what case management domain?
Psychosocial and economic issues.
What does unit based case management mean and what model is it under?
CM follows while on a specific unit; acute care model.
What does complete based case management mean and what model is it under?
CM follows from admission to discharge; acute care model.
What does disease based case management mean and what model is it under?
CM follows patients according to illness; acute care model.
What does practice based case management mean and what model is it under?
CM follows patients according to physician; acute care model.
What does primary based case management mean and what model is it under?
CM is the primary nurse for certain patients; acute care model.
What is the role of the CM in the skilled nursing facility model?
Acts as a liaison between acute and sub acute care levels.
What is the CM role in the Rehab CM model?
Works to bring patient to functional level that is close to their baseline.
What is the CM role in the community based CM model?
Help families and patients access services for independent functioning and prevent further exacerbations.
What is the CM role in the independent CM model?
CM works with firms that are not a formal part of an insurance company or other healthcare related facility.
How is hospital payment calculated?
Multiplying relative weight with facility’s base rate.
What is the caseload matrix?
Used in caseload calculations to identify variables in different settings.
What is the case mix index (CMI)?
Sum of all DRG related weights divided by number of patients cared for during a specific time (usually one year).
What is the difference between acute onset, recent onset, and newly discovered?
Acute - within 24h
Recent - within 1 week
New onset > 1 week
Newly discovered - during this illness
What do discharge screens indicate?
If the patient is clinically ready for discharge or transfer and if patient is stable enough for this process.
What does the medical social case management model focus on?
The long term care patient who is at risk for hospitalization. Involves utilization of services that are typically not covered but will maintain patient in the home.
What does historical healthcare data cover?
A particular patient, device or thing.
What type of database is used by nurse managers and analysts for population based management and contains financial and clinical data.
Data warehouse
What type of database is designed to facilitate providers decision making regarding each patient? Focus is on clinical and operational data available in real time.
Data repository.
How did case management start?
In response to the prospective payment system in acute care.
HARP, PRA and BRASS are screening tools related to what?
Discharge and whether a patient is likely to suffer adverse health consequences.
Each MDG has up to how many DRG’s?
1-20
