Course Provider
Learning Objectives
Improving Transitional Care - Learning Objectives: Identify critical transitions of care points that require management (CM) services. Differentiate between high-risk and low-risk transitions across different settings of care. Identify different interventions for facilitating safe transitions of care. Explain the importance of post-discharge follow-up care and its timeliness. Explain the importance of repeat assessment and care plan updates with health status changes to minimize risk of transitions and handoff. Explain necessary documentation to maintain the integrity of the medical record and provide necessary and timely care for patients. Delineate differentiation between primary, secondary, and tertiary prevention strategies during care transition. Identify effectiveness of transitional care effectiveness. Explain proper documentation to maintain regulatory and accreditation standards. Explain key transitions of care (TOC) services to assure client safety and adherence with the care plan.
Inter-Agency and Multi-Program Coordination - Learning Objectives: Describe the complications associated with inter-agency and multiple programs. Define coordination, collaboration, interdisciplinary, and continuity of care relative to diverse care management systems. List potential challenges and barriers care managers face when coordinating and collaborating within agency departments or amongst multiple programs from the perspective of the individual professional, the care team system, the individual organizations. Describe structural and systemic barriers including funding sources, regulatory issues, and legal and ethical considerations care managers may encounter when attempting to work together. Explain the impact on person-centered care when diverse care management system work in an uncoordinated and non-collaborative manner versus a coordinated and collaborative system of care delivery. Describe best practices for information sharing and networking inter-agency or across multiple programs. Apply strategies for negotiating power and leadership within the diverse care management system. Outline the stages for obtaining organizational buy-in when moving from a system of isolation to one of integration. List best practices for transform the current system into one that builds efficiency and more complementary service delivery inter-agency or across multiple programs.
Triage - Learning Objectives: Explain Triage Care Management (CM) practices. Differentiate between Triage CM across different settings (Acute care hospital vs. health plan). Identify different sources of referrals to Triage CM intake. Explain the Triage CM process. Explain risk stratification levels as a Triage CM function. List domains of assessment and prioritize needs for case assignment. Explain necessary documentation to maintain the integrity of the medical record and provide necessary and timely care for patients. Identify the effectiveness of Triage CM.
Critical Thinking Skills and High Risk Management - Learning Objectives: Define critical thinking. Describe the importance and differences amongst types of questions in the critical thought process. Demonstrate how to ask meaningful and insightful questions that lead to strategic care planning. Explain reasoning, inquiry, and reflective thinking. Apply critical thinking best practices to care management. Define high-risk. Describe the high-risk patient and their experience in healthcare. List the most common chronic condition of high-risk patients and link the prevalence of specific chronic illness to cost of care based on healthcare insurance coverage