CCP Chronic Disease Management & Care Coordination 2

Question 1

A care coordinator notices a patient with heart failure has been hospitalized three times in six months. Which intervention is MOST likely to reduce readmissions?

Accepted Answer

Implementing a structured post-discharge follow-up call within 48–72 hours

Answer

Post-discharge follow-up calls within 48–72 hours are evidence-based interventions proven to reduce heart failure readmissions by catching early warning signs.

Question 2

The Chronic Care Model (CCM) identifies which of the following as a core component that supports informed, activated patients?

Accepted Answer

Self-management support

Answer

Self-management support is one of the six core elements of the Chronic Care Model, empowering patients to actively participate in managing their own conditions.

Question 3

When developing a care plan for a patient with multiple chronic conditions, which approach is considered BEST practice?

Accepted Answer

Creating a unified, patient-centered care plan that addresses all conditions holistically

Answer

A unified, patient-centered care plan that addresses comorbidities holistically prevents fragmented care and reduces the risk of conflicting treatments.

Question 4

Which metric is MOST appropriate for evaluating the effectiveness of a diabetes chronic care management program?

Accepted Answer

Percentage of patients achieving HbA1c targets

Answer

HbA1c target achievement is the primary clinical outcome measure used to evaluate diabetes management program effectiveness.

Question 5

A care team member identifies that a patient's medications from three different prescribers contain a dangerous drug-drug interaction. The FIRST step should be to:

Accepted Answer

Alert the prescribing providers immediately and document the finding

Answer

Alerting all prescribing providers immediately ensures patient safety and facilitates prompt medication reconciliation across the care team.

(CCP) Chronic Care Professional Certification Practice Test

(CCP) Chronic Care Professional Certification Practice Test

CCP Chronic Disease Management & Care Coordination 2