AHIP AHM-540 echte frage : Medical Management

Elaine Newman suffered an acute asthma attack and was taken to a hospital emergency department for treatment. Because Ms. Newman's condition had not improved enough following treatment to warrant immediate release, she was transferred to an observation care unit. Transferring Ms. Newman to the observation care unit most likely

• A. prevented Ms. Newman from receiving immediate attention for her condition
• B. allowed clinical staff an opportunity to determine whether Ms. Newman required hospitalization without actually admitting her
• C. resulted in unnecessarily expensive charges for treatment
• D. gave Ms. Newman access to more effective and efficient treatment than she could have obtained from other providers in the same region

Readiness is an important consideration for the development of health promotion programs. Readiness refers to

• A. a member's access to information technology, such as a video cassette recorder, a computer, or the Internet
• B. the appropriateness of a program's educational approach, given the language, literacy level, and cultural sensitivities of the target population
• C. a member's level of knowledge about existing health risks and problems and the member's ability and willingness to adopt new health-related behaviors
• D. the availability of previously established health promotion programs to an health plan's members through employers, providers, or community service agencies

The case management team at the Hightower Health Plan reviewed the medical records of the following two plan members to determine the type of care each one needs and the most appropriate setting for that care:
Ira Morton was hospitalized for a severe stroke. Although his medical condition is stable, the stroke left him partially paralyzed and he will require extensive rehabilitation and 24hour medical care.
Theresa Finley is recovering from a total hip replacement and is in need of short-term physical therapy and twice-weekly visits from a licensed nurse to check her blood pressure and the healing of her incision.
From the answer choices below, select the response that correctly identifies the level of care that would be most appropriate for Mr. Morton and Ms. Finley.

• A. Mr. Morton-skilled care Ms. Finley-palliative care
• B. Mr. Morton-acute care Ms. Finley-subacute care
• C. Mr. Morton-palliative care Ms. Finley-acute care
• D. Mr. Morton-subacute care Ms. Finley-skilled care

One method of transferring the information in electronic medical records (EMRs) is through a health information network (HIN). The following statements are about HINs. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.

• A. A HIN may afford a health plan better measurements of outcomes and provider performance.
• B. Currently, the majority of health plans do not have HINs that are capable of transferring medical records among their network providers.
• C. Most HINs are Internet-based rather than built on proprietary computer networks.
• D. The use of a HIN typically increases a health plan's exposure to liability for poor care.

Health plans communicate proposed performance changes through action statements. Select the answer choice containing an action statement that includes all of the required elements.

• A. The QM program director will evaluate the level of provider compliance with clinical practice guidelines (CPGs).
• B. The disease management program director will increase participation by asthmatic children in the health plan's pediatric asthma disease management program.
• C. The proportion of adult members who are screened for hypertension will increase by ten percent.
• D. Primary care providers (PCPs) will increase the proportion of children under the age of two who are up-to-date on immunizations by seven percent within one year.