WGU D046 question and answers 2022

WGU D046 question and answers 2022What is an important part of the decision to pursue hospice or palliative care? Part of the decision whether to pursue hospice or palliative care has to do with payer sources and the level of hospice care a patient wishes to receive. The accountable care organization (ACO) The accountable care organization (ACO) is a new type of health care organization incentivized to improve quality of care, improve population health, and reduce the total cost of care. What are case management models? Models include the ambulatory integration of the medical and social model (AIMS), the wraparound care coordination model, the patient-centered medical home (PCMH), and the medical neighborhood collaborative care model. What are the four steps the AIMS Model encompasses? 1-Patient engagement 2-Assessment and care plan development 3-Case management 4-Ongoing care as needed What kind of coordination does the Wraparound Care Model provide? For whom? provide team-based care coordination for children and youth with complex behavioral health needs. This model was created to serve a need for care of youth with complex physical and behavioral health needs for which care was either duplicated, involved unnecessary services, or lacked the support and resources to achieve the young patient's health care goals What is the PCMH Medical Neighborhood Collaborative Care Model? the concept of a medical neighborhood, in which a patient's primary provider may be considered their Patient-Centered Medical Home (PCMH). That medical home may then interact with a "neighborhood" of community resources, including a team of outpatient caregivers, specialists, hospitals, mental/behavioral health resources, and non-medical community resources. What is the case management process flow? -Patient engagement activities -Interview with the patient to gain their medical history as well, gain demographic information and learn the patient's goals and needs -Construction of a Coordinated Care Conference for the assembly of a coordinated care team that will be led by a Lead Care Coordinator -Management of the care team and collaborative efforts as part of the case management process How do you set the stage using appropriate communication skills? -Greet patient appropriately and acknowledge the wait time if needed -Find out how the patient is feeling about the consultation -Introduce the computer into the coordinator-patient triad -Explain and reassure the patient of confidentiality of EMR Explain the importance of active listening. -Shows the patient that you care -Establishes trust in a healthcare professional-patient relationship -Lessens your chance of erroneous information capture or decision-making, based on your own assumptions -Increases the chances that you will procure pertinent information What is telemedicine? also sometimes referred to as telehealth or remote healthcare, continues to evolve, both in terms of the technology used and the capacity of providers to provide a wider range of remote healthcare services to patients and their families. Remote patient monitoring involves integrated devices that connect with providers, so necessary interventions may be administered in a more timely manner and prevent escalation of serious health conditions that could result in hospitalization. What is culturally competent care? caregivers understand and attend to the total context of the individual's situation, including awareness of immigration status, stress factors, other social factors, and cultural similarities and differences What is transitional care? activities that prevent repeated and avoidable re-admissions and negative health outcomes after a hospital discharge What are the phases of the population care coordination intervention process? -data analysis and selection -assessment -planning -interventions -evaluations -individualization What is DICE? (duration, integrity, commitment, and effort) outlines those additional change factors to manage with employees and other stakeholders. What is SWOT? Strengths-are considered attributes weighed as positive to an organization's internal environment. Weaknesses- harmful or negative qualities. Opportunities-are external factors considered to be favorable to an organization. Threats-are external factors perceived to be adverse or unfavorable. What is ADKAR? Awareness- Individual awareness of the need for change Desire- Individual desire to participate and support the change Knowledge- Individual knowledge regarding how to change Ability- Individual ability to implement new skills and behaviors Reinforcement- Individual level reinforcement for keeping newly acquired skills and behaviors in place What are the four steps of the safety net medical home initiative? 1. laying the foundation-quality improvement, engaged leadership 2. building relationships- empanelment, continuous team based healing 3. changing care delivery-patient centered interactions, organized evidence based care 4. reducing barriers to care-cared coordination, enhanced access What are the factors to consider when assembling a case management plan of care? -Data gathering format -Development strategies -Factors in patient acuity determination -Verification of the appropriate resources and case management plans that allow UM-driven evidence-based clinical guidelines and clinical pathways that will lead to optimal patient health outcomes. assessment phase of care coordination plan During the assessment phase of this subpopulation, the full interview and assessment of a specific client are reviewed and considered. The assessment should include the client, family, community, services currently utilized, and potential future needs. A comprehensive needs assessment is completed during this phase and will need to stay updated as the patient transitions. planning phase of care coordination plan Planning occurs after the identification of the potential services needed. Creation of the care team and identification of the care coordination plan will begin. This improves the process of including the right care team members to the initial planning stages with the care team. Client engagement will be needed to ensure the success of the care delivery path, as it usually requires the client and family to adapt or adopt new practices or services into their daily living. interventions phase of care coordination plan The goals for the interventions will fall into three categories: prevention, transition of care, and chronic care. All interventions should be supported through evidence-based practices when possible. Ensuring that the client receives the immediate care delivery for the moment is important; ensuring that interventions to support those plans and treatments in the future needs to be worked on by all members of the team. evaluation phase of care coordination plan Evaluation is an analysis of the plan, the interventions, and the outcomes. This phase is ongoing and will lead to reevaluations based on the outcomes and the continuous cycle of improving the outcome for the client as well as in analysis of the ongoing nature of diseases. Some conditions will be short-lived and can be resolved, whereas other problems or conditions are chronic with exacerbation, remission, or maintenance cycles. All of this will factor into the ongoing nature of dealing with clients in the healthcare setting individualization phase of care coordination plan The final stage is the ongoing individualization of the plan to meet the needs of the client, the family, the environment, and the community. This occurs after and along with the continual evaluation, since the overarching plan requires ongoing and concurrent evaluation and individualization according to the client's needs. Only at resolution is a care coordination plan ever complete, although this will be impacted by a re-entry into another episode of care cognitive reframing a form of cognitive-behavioral therapy that assists individuals in reframing their thinking about the stressors in their lives to promote positive rather than negative perspectives? What is motivational interviewing? a client-centered, directive method for