CCM (SEC) flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Case management process steps

Screening, assessment, care planning, implementation and coordination, monitoring and follow-up, and evaluation with closure. Each step produces documented output that feeds the next step.

SMART goal criteria

Goals must be Specific, Measurable, Achievable, Relevant, and Time-bound. A compliant goal names the behavior, the target value, the deadline, and who is accountable.

Level of care selection

Choose the least restrictive setting that can safely deliver the required interventions. Escalate only when safety, complexity, or caregiver capacity exceeds that setting's ability.

Transition of care bundle

Medication reconciliation, a follow-up appointment scheduled before discharge, a written self-management plan, and a named contact for questions after discharge.

Caseload calculation

Available direct-care hours per week divided by average hours required per case per week equals the defensible caseload ceiling for a case manager.

Case closure criteria

Goals met, patient declined services, patient relocated, benefits exhausted, or a safety event requiring a different level of care. Document the specific reason at closure.

Screening versus assessment

Screening applies objective triggers such as risk score, diagnosis, or utilization threshold to identify who needs services. Assessment then gathers detailed clinical, functional, psychosocial, and financial data.

Documentation linkage rule

Each documented intervention should link to a specific plan goal. An intervention with no linked goal generally cannot be justified as case management to a payer.

Stages of change

Precontemplation, contemplation, preparation, action, and maintenance. Interventions must match the current stage; mismatching the stage predicts disengagement and dropout.

Motivational interviewing OARS

Open questions, Affirmations, Reflections, and Summaries. The purpose is to elicit change talk from the patient rather than to argue for behavior change.

Worden grief tasks

Accept the reality of the loss, process the pain of grief, adjust to a world without the deceased, and relocate the relationship while continuing life.

Crisis intervention sequence

Ensure safety, establish rapport, identify the problem, explore feelings, generate alternatives, formulate an action plan, and arrange follow-up contact.

PHQ-9 and GAD-7

PHQ-9 screens depression severity across nine items; GAD-7 screens anxiety severity across seven items. A positive screen prompts clinical assessment, not a diagnosis.

Suicide risk factors

Prior attempt, access to lethal means, substance use, recent loss, and social isolation. Protective factors include social support, reasons for living, and engagement in care.

Teach-back method

Ask the patient to explain the plan in their own words, for example how they will take a medication. It verifies comprehension rather than assuming it.

Caregiver burden screening

Structured tools such as the Zarit Burden Interview quantify caregiver strain. High burden predicts avoidable readmission and institutional placement, so it belongs in the care plan.

Cultural humility in care

Elicit the patient's explanatory model of the illness, then negotiate a plan consistent with their beliefs, family roles, and preferred language.

Health literacy materials

Patient education materials should target roughly a fifth-to-sixth grade reading level and use plain words, short sentences, and pictures to support comprehension.

Donabedian framework

Quality is examined through structure (resources and staffing), process (what is done), and outcome (the result). Process measures are used when outcomes are rare or delayed.

PDSA cycle

Plan, Do, Study, Act. Small rapid tests of change are run and studied before a change is spread system-wide.

Root cause analysis

A retrospective, event-focused method using repeated why questioning and a fishbone diagram to identify underlying system causes of an adverse event.

FMEA purpose

A prospective method that scores each process step by severity times occurrence times detection, producing a risk priority number used to target improvement.

Rate calculation

A rate equals the numerator divided by the denominator, multiplied by 100 for a percentage. The population and time period must be stated explicitly.

Validity versus reliability

Validity is measuring what is intended; reliability is consistency across raters or occasions. Inter-rater reliability is often reported as kappa or percent agreement.

Control chart signal

A data point outside the control limits indicates special-cause variation. Variation within limits is common cause and is not fixed by blaming individuals.

Patient-reported outcome measures

Instruments such as PROMIS or SF-36 capture function and quality of life from the patient's perspective. They complement clinical and utilization data.

Benchmarking requirement

Performance is compared with an internal baseline, external peer group, or published standard. A benchmark without a defined denominator is not a valid comparison.

FIM instrument

The Functional Independence Measure has 18 items across motor and cognitive subscales, each scored 1 to 7, with higher scores indicating greater independence.

Berg Balance Scale

Fourteen balance tasks scored 0 to 56. Scores below 45 indicate increased fall risk and warrant closer supervision and intervention.

ADL versus IADL

ADLs are self-care tasks such as bathing, dressing, toileting, transfers, and feeding. IADLs are community tasks such as medication management, finances, shopping, and transport.

Restraint use requirements

Least restrictive intervention is tried first. A restraint requires a physician order, time-limited duration, ongoing monitoring, and periodic reassessment of need.

Pressure injury prevention

Repositioning schedules, appropriate support surfaces, moisture and nutrition management, and regular skin inspection. Staging uses the NPUAP/EPUAP system from Stage 1 through unstageable.