Case Management Nurse Exam with Verified Question and
Answer
Outcome indicators - Correct Answer -Measures of quality and cost of care. Metrics used to examine
and evaluate the results of the care delivered.
Outcome Management - Correct Answer -The use of information and knowledge gained from
outcomes monitoring to achieve optimal client outcomes through improved clinical decision making
and service delivery.
Outcomes Measurement - Correct Answer -systemic, quantitative observation, at a point in time, of
outcome indicators
Outcome Monitoring - Correct Answer -repeated measurement over time of outcome indicators in a
manner that permits causal inferences about which patient characteristics, care processes, and
resources produced the observed patient outcomes.
Performance improve - Correct Answer -The continuous study and adaptation of the functions and
processes of a healthcare organization to increase the probability of achieving desired outcomes and
to better
Meet the needs of patients.
Quality Assurance - Correct Answer -Use of activities and programs to ensure the quality of the
patient care. These activities are designed to monitor, prevent, and correct quality deficiencies and
non-compliant with the standards of care and practice.
Quality Improvement - Correct Answer -Used to identify/resolve problems in the system and to
improve the processes and outcomes of care.
Quality Indicator - Correct Answer -A predetermined measure for assessing quality; a metric.
Quality Management - Correct Answer -A total commitment by everyone in an organization to improve
the quality of procedures and products by reducing waste, errors, and defects.
Case management process: - Correct Answer -Screening
Assessing
Stratifying risk
Planning
Implementing
Following up
Transitioning
Communication
Evaluation
Stratifying Risk - Correct Answer -phase that determines the appropriate level of intervention by
classifying the pt. as low or high risk.
SMART planning - Correct Answer -Specific
Measurable
Achievable
Realistic
Timely
3 types of measurements of performance improvement - Correct Answer -1) process
2) Structure
3) Outcome
Examples of hard savings: - Correct Answer -transfer to a lower level of care
Decrease in length of stay
1
, Negotiation to a lower rate for a service
Change to an in-network provider
Examples of soft savings: - Correct Answer -avoided hospital readmission
Prevention of medical complications
Avoided ER visits.
4 components of interpersonal communication - Correct Answer -sender
Message
Receiver
Context
Principles of motivational interview - Correct Answer -1) express empathy
2) Support self-efficacy
3) Roll with resistance
4) Recognize discrepancy
Conflict resolution strategies - Correct Answer -1) collaboration
2) Negotiation
3) Accommodation
4) Competitive
5) Avoidance
Accreditation - Correct Answer -entails voluntary survey process that assesses the extent of a
healthcare organization's compliance with the standards to improve patient outcomes
Beneficence - Correct Answer -to do well
CARF - Commission on Accreditation of Rehabilitation Facilities - Correct Answer -Private, non-profit
establishes standards of quality for services to people w/ disabilities. Offers voluntary accreditation to
rehab facilities
Health and Human Services Risk Management - Correct Answer -The science of the identification,
evaluation, and treatment of financial (and clinical) loss. A program that attempts to provide positive
avoidance of negative results
Non-maleficence - Correct Answer -refraining from doing harm to others
URAC - Utilization Review Accreditation C - Correct Answer -Provides reviews and accreditation for
UR services/programs provided by freestanding agencies
5 basis ethical principles - Correct Answer -Beneficence
Non-malfeasance
Autonomy
Justice
Fidelity
NCQA - National - Correct Answer -Comprehensive, EB accreditation program dedicated to quality
improvement.
NQF - N - Correct Answer -membership based organization designed to develop and implement a
national strategy for healthcare quality measurement and reporting
Principle/Agent - Correct Answer -Doctor is agent employed by hospital (principal). Dry authorized to
act on behalf of hospital but hospital is responsible.
ADA - American Disabilities Act defines a disability - Correct Answer -1) has a physical or mental
impairment that limits a major life activity
2) Has a record or history of a substantially limiting impairment
3) Is regarded by ER as having a substantially limiting impairment
2
Answer
Outcome indicators - Correct Answer -Measures of quality and cost of care. Metrics used to examine
and evaluate the results of the care delivered.
Outcome Management - Correct Answer -The use of information and knowledge gained from
outcomes monitoring to achieve optimal client outcomes through improved clinical decision making
and service delivery.
Outcomes Measurement - Correct Answer -systemic, quantitative observation, at a point in time, of
outcome indicators
Outcome Monitoring - Correct Answer -repeated measurement over time of outcome indicators in a
manner that permits causal inferences about which patient characteristics, care processes, and
resources produced the observed patient outcomes.
Performance improve - Correct Answer -The continuous study and adaptation of the functions and
processes of a healthcare organization to increase the probability of achieving desired outcomes and
to better
Meet the needs of patients.
Quality Assurance - Correct Answer -Use of activities and programs to ensure the quality of the
patient care. These activities are designed to monitor, prevent, and correct quality deficiencies and
non-compliant with the standards of care and practice.
Quality Improvement - Correct Answer -Used to identify/resolve problems in the system and to
improve the processes and outcomes of care.
Quality Indicator - Correct Answer -A predetermined measure for assessing quality; a metric.
Quality Management - Correct Answer -A total commitment by everyone in an organization to improve
the quality of procedures and products by reducing waste, errors, and defects.
Case management process: - Correct Answer -Screening
Assessing
Stratifying risk
Planning
Implementing
Following up
Transitioning
Communication
Evaluation
Stratifying Risk - Correct Answer -phase that determines the appropriate level of intervention by
classifying the pt. as low or high risk.
SMART planning - Correct Answer -Specific
Measurable
Achievable
Realistic
Timely
3 types of measurements of performance improvement - Correct Answer -1) process
2) Structure
3) Outcome
Examples of hard savings: - Correct Answer -transfer to a lower level of care
Decrease in length of stay
1
, Negotiation to a lower rate for a service
Change to an in-network provider
Examples of soft savings: - Correct Answer -avoided hospital readmission
Prevention of medical complications
Avoided ER visits.
4 components of interpersonal communication - Correct Answer -sender
Message
Receiver
Context
Principles of motivational interview - Correct Answer -1) express empathy
2) Support self-efficacy
3) Roll with resistance
4) Recognize discrepancy
Conflict resolution strategies - Correct Answer -1) collaboration
2) Negotiation
3) Accommodation
4) Competitive
5) Avoidance
Accreditation - Correct Answer -entails voluntary survey process that assesses the extent of a
healthcare organization's compliance with the standards to improve patient outcomes
Beneficence - Correct Answer -to do well
CARF - Commission on Accreditation of Rehabilitation Facilities - Correct Answer -Private, non-profit
establishes standards of quality for services to people w/ disabilities. Offers voluntary accreditation to
rehab facilities
Health and Human Services Risk Management - Correct Answer -The science of the identification,
evaluation, and treatment of financial (and clinical) loss. A program that attempts to provide positive
avoidance of negative results
Non-maleficence - Correct Answer -refraining from doing harm to others
URAC - Utilization Review Accreditation C - Correct Answer -Provides reviews and accreditation for
UR services/programs provided by freestanding agencies
5 basis ethical principles - Correct Answer -Beneficence
Non-malfeasance
Autonomy
Justice
Fidelity
NCQA - National - Correct Answer -Comprehensive, EB accreditation program dedicated to quality
improvement.
NQF - N - Correct Answer -membership based organization designed to develop and implement a
national strategy for healthcare quality measurement and reporting
Principle/Agent - Correct Answer -Doctor is agent employed by hospital (principal). Dry authorized to
act on behalf of hospital but hospital is responsible.
ADA - American Disabilities Act defines a disability - Correct Answer -1) has a physical or mental
impairment that limits a major life activity
2) Has a record or history of a substantially limiting impairment
3) Is regarded by ER as having a substantially limiting impairment
2
