Care Management for Seriously Ill Patients: Addressing Gaps in Care
What You’ll Learn
- Describe the common needs of people with serious illness
- Define the role of the care manager in supporting the seriously ill patient’s optimal care and quality of life
- Identify steps care managers can take to identify needs and address barriers to care for people with serious illness and their families
- Initiate conversations about serious illness with patients, and build an effective, trusting telephonic relationship
What You’ll Earn
Only CAPC members who are logged in can earn the following free Continuing Education Credits:
- Case Management: 1.00 CE
- Medicine: 0.75 CME, 0.75 ABIM MOC (Medical Knowledge Only)
- Nursing: 1.00 CNE
- Social Work: 1.00 CE (NYSED)
- Social Work: 1.00 CE (NASW)
Tools & Resources
One-page guide for care managers on techniques to address the needs of patients with serious illness and their caregivers. Center to Advance Palliative Care, 2017.
Specific phrases care managers can use to elicit information from patients or members about thier quality of life. Center to Advance Palliative Care, 2017.
Recommended assessment questions to typify pain and inform pain management for patients with serious illness. Center to Advance Palliative Care, 2015.
Self-reported caregiver assessment.
Brief (4-question) screening tool for anxiety and depression.
Assesses for nine symptoms experienced by patients with serious illness and quantifies their severity. Alberta Health Services.
Assessment tool for symptom burden and impact on quality of life. National Comprehensive Cancer Network (NCCN), 2016.
Suggested CAPC courses and tools for care managers. Center to Advance Palliative Care, 2018.
Find recommended CAPC courses and tools based on your specialty, discipline, or area of interest. CAPC courses provide free continuing education credits for all staff at member organizations, and ABIM MOC points for physicians.
Communication techniques to elicit patient decisions, with the goal of supporting patient autonomy. Journal of Palliative Medicine, 2011.
Ruth MacIntosh, (Ret). Continuum of Care Manager of Aetna Compassionate Care Program NCM
Tom Gualtieri-Reed, MBA. Consultant, Spragens & Associates, LLC.
Allison Silvers, MBA. Vice President, Payment and Policy, Center to Advance Palliative Care.
Amy Case, MD, FAAHPM. Associate Professor of Oncology, Chair, Department of Supportive Care.*
Melissa Bakar, MD. Assistant Professor, Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai.*
Ankita Mehta, MD. Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai.
*indicates ABIM Peer Reviewer