CCM Quality and Outcomes Measurement 5 — Questions and Answers
Question 1: A case manager is using a Likert scale questionnaire to assess patient functional status. This instrument measures which type of outcome?
- Clinical biomarker outcome
- Patient-reported outcome (Correct answer)
- Utilization outcome
- Financial outcome
Correct answer: Patient-reported outcome
Likert scale questionnaires completed by patients to assess functional status are patient-reported outcome measures (PROMs) that capture self-perceived health.
Question 2: Which quality improvement method uses 'rapid-cycle' tests of change in small samples before spreading system-wide?
- Six Sigma DMAIC
- Model for Improvement (IHI) (Correct answer)
- Root cause analysis
- Failure Mode and Effects Analysis
Correct answer: Model for Improvement (IHI)
The IHI Model for Improvement employs rapid Plan-Do-Study-Act (PDSA) cycles to test changes quickly and learn before broader implementation.
Question 3: A health plan's case management program demonstrates a reduction in average hospital days per 1,000 members. This is an example of:
- A structural quality measure
- A utilization outcome metric (Correct answer)
- A patient safety indicator
- A process compliance rate
Correct answer: A utilization outcome metric
Hospital days per 1,000 members is a utilization outcome metric that quantifies inpatient resource use across a population.
Question 4: When reporting quality outcomes, 'risk adjustment' is performed in order to:
- Increase reimbursement rates for complex patients
- Account for differences in patient populations when comparing providers or programs (Correct answer)
- Simplify data collection processes
- Assign ICD codes more accurately
Correct answer: Account for differences in patient populations when comparing providers or programs
Risk adjustment controls for differences in patient acuity and demographics so that outcome comparisons between programs or providers are fair and valid.
Question 5: A case manager is reviewing a run chart for asthma action plan completion rates over 12 months. The PRIMARY purpose of this tool is to:
- Calculate the cost per completed action plan
- Detect trends and patterns in performance over time (Correct answer)
- Identify which patients refused action plans
- Determine staffing ratios
Correct answer: Detect trends and patterns in performance over time
Run charts display data over time and are used in quality improvement to detect trends, shifts, and patterns that indicate whether a process is improving.
Question 6: Which scenario BEST illustrates 'sentinel event' reporting in a case management context?
- A patient misses two follow-up appointments
- A patient dies unexpectedly due to a medication error during a care transition (Correct answer)
- A case manager fails to document a phone call
- A patient's insurance claim is denied
Correct answer: A patient dies unexpectedly due to a medication error during a care transition
A sentinel event is an unexpected occurrence involving death or serious physical or psychological harm, such as a fatal medication error, requiring immediate investigation.
Question 7: In population health management, 'stratification' of a patient population is used to:
- Determine which patients have the most insurance coverage
- Categorize patients by risk level to prioritize case management resources (Correct answer)
- Assign diagnosis codes for billing purposes
- Rank providers by quality scores
Correct answer: Categorize patients by risk level to prioritize case management resources
Risk stratification categorizes patients from low to high risk so that intensive case management resources are directed to those with the greatest need.
CCM Quality and Outcomes Measurement 5
A case manager is using a Likert scale questionnaire to assess patient functional status.
This instrument measures which type of outcome?