CCM Clinical Assessment & Risk Management 2 — Questions and Answers
Question 1: A case manager identifies that a 78-year-old patient with heart failure has missed three consecutive medication refills. Which risk factor does this most directly indicate?
- Caregiver burnout
- Medication non-adherence risk (Correct answer)
- Financial hardship only
- Cognitive impairment
Correct answer: Medication non-adherence risk
Missed medication refills are a direct indicator of medication non-adherence risk, which significantly increases rehospitalization risk in heart failure patients.
Question 2: The LACE Index is used in care management to predict which of the following?
- Likelihood of medication side effects
- 30-day hospital readmission risk (Correct answer)
- Caregiver stress levels
- Patient satisfaction scores
Correct answer: 30-day hospital readmission risk
The LACE Index (Length of stay, Acuity of admission, Comorbidities, Emergency visits) is a validated tool for predicting 30-day hospital readmission risk.
Question 3: When conducting a functional assessment, which tool specifically measures a patient's ability to perform instrumental activities of daily living (IADLs)?
- Braden Scale
- Lawton IADL Scale (Correct answer)
- Barthel Index
- Glasgow Coma Scale
Correct answer: Lawton IADL Scale
The Lawton IADL Scale assesses complex tasks such as managing finances, using transportation, and preparing meals that are classified as instrumental ADLs.
Question 4: A case manager notices a patient's PHQ-9 score increased from 5 to 14 over the past month. What is the most appropriate immediate action?
- Schedule a routine follow-up in 90 days
- Notify the treating physician and escalate the care plan (Correct answer)
- Discharge the patient from case management
- Refer the patient to physical therapy
Correct answer: Notify the treating physician and escalate the care plan
A PHQ-9 score of 14 indicates moderate depression; a significant increase warrants immediate physician notification and care plan escalation to prevent deterioration.
Question 5: Which principle of risk stratification ensures that the highest-intensity case management resources are directed toward patients with the greatest clinical need?
- Universal screening
- Population segmentation (Correct answer)
- Utilization management
- Discharge planning
Correct answer: Population segmentation
Population segmentation stratifies patients by risk level so that intensive case management resources are allocated to high-risk individuals who will benefit most.
Question 6: A patient with COPD reports using their rescue inhaler more than twice per week. According to clinical guidelines, this pattern suggests:
- Well-controlled disease
- Poorly controlled disease requiring care plan revision (Correct answer)
- Normal inhaler usage for COPD
- Need to discontinue inhaler therapy
Correct answer: Poorly controlled disease requiring care plan revision
Rescue inhaler use more than twice per week is a clinical marker of poorly controlled COPD or asthma, signaling the need for care plan revision.
Question 7: During a home visit, a case manager observes expired food in the refrigerator, unpaid utility bills, and a confused patient living alone. Which risk domain is most immediately threatened?
- Occupational functioning
- Social determinants and safety risk (Correct answer)
- Insurance coverage status
- Transportation access
Correct answer: Social determinants and safety risk
The combination of food insecurity, financial strain, utility risk, and cognitive confusion indicates an acute social determinants and safety risk requiring urgent intervention.
CCM Clinical Assessment & Risk Management 2
A case manager identifies that a 78-year-old patient with heart failure has missed three consecutive medication refills.
Which risk factor does this most directly indicate?