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質問 1：
By definition, the development and implementation of parameters for the delivery of healthcare services to a health plan's members is known as
A. utilization management (UM)
B. clinical practice management
C. quality management (QM)
D. care management
正解：B
質問 2：
To see that utilization guidelines are consistently applied, UR programs rely on authorization systems. Determine whether the following statement about authorization systems is true or false:
Only physicians can make nonauthorization decisions based on medical necessity.
A. False
B. True
正解：B
質問 3：
To measure performance for quality management, health plans collect and analyze three types of data: financial data, clinical data, and customer satisfaction data. The following statement(s) can correctly be made about the sources of clinical data:
1.Patient surveys are the most widely used source of disease-specific clinical information
2.Outcomes research studies sponsored by academic institutions and professional organizations have limited usefulness for particular health plans or individual providers
3.The SF-36 and the HSQ-39 (Health Status Questionnaire) surveys address both physical and mental health status
A. All of the above
B. 2 and 3 only
C. 3 only
D. 1 and 2 only
正解：B
質問 4：
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-palliative care Ms. Finley-acute care
C. Mr. Morton-acute care Ms. Finley-subacute care
D. Mr. Morton-subacute care Ms. Finley-skilled care
正解：D
質問 5：
The following statements are about the use of hospitalists to manage inpatient care. Select the answer choice containing the correct statement.
A. A patient who has been transferred to a hospitalist for management of inpatient care usually continues to receive care from the hospitalist after discharge.
B. In order to serve as a hospitalist, a physician must have a background in critical care medicine.
C. Hospitalists are used primarily to manage care for obstetric, pediatric, and oncology patients.
D. Hospitalists typically spend at least one-quarter of their time in a hospital setting.
正解：D
By definition, the development and implementation of parameters for the delivery of healthcare services to a health plan's members is known as
A. utilization management (UM)
B. clinical practice management
C. quality management (QM)
D. care management
正解：B
質問 2：
To see that utilization guidelines are consistently applied, UR programs rely on authorization systems. Determine whether the following statement about authorization systems is true or false:
Only physicians can make nonauthorization decisions based on medical necessity.
A. False
B. True
正解：B
質問 3：
To measure performance for quality management, health plans collect and analyze three types of data: financial data, clinical data, and customer satisfaction data. The following statement(s) can correctly be made about the sources of clinical data:
1.Patient surveys are the most widely used source of disease-specific clinical information
2.Outcomes research studies sponsored by academic institutions and professional organizations have limited usefulness for particular health plans or individual providers
3.The SF-36 and the HSQ-39 (Health Status Questionnaire) surveys address both physical and mental health status
A. All of the above
B. 2 and 3 only
C. 3 only
D. 1 and 2 only
正解：B
質問 4：
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-palliative care Ms. Finley-acute care
C. Mr. Morton-acute care Ms. Finley-subacute care
D. Mr. Morton-subacute care Ms. Finley-skilled care
正解：D
質問 5：
The following statements are about the use of hospitalists to manage inpatient care. Select the answer choice containing the correct statement.
A. A patient who has been transferred to a hospitalist for management of inpatient care usually continues to receive care from the hospitalist after discharge.
B. In order to serve as a hospitalist, a physician must have a background in critical care medicine.
C. Hospitalists are used primarily to manage care for obstetric, pediatric, and oncology patients.
D. Hospitalists typically spend at least one-quarter of their time in a hospital setting.
正解：D
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