Care Management for Seriously Ill Patients: Addressing Gaps in Care

Last Reviewed: September 1, 2017

What You’ll Learn

  1. Describe the common needs of people with serious illness
  2. Define the role of the care manager in supporting the seriously ill patient’s optimal care and quality of life
  3. Identify steps care managers can take to identify needs and address barriers to care for people with serious illness and their families
  4. Initiate conversations about serious illness with patients, and build an effective, trusting telephonic relationship

What You’ll Earn

CAPC members can earn the following free continuing education credits:

Case Management: 1.00 CE
Licensed Professional Counselors: 1.00 CE
Medicine: 0.75 CME, 0.75 ABIM MOC
Nursing: 1.00 CNE
Social Work: 1.00 CE (NASW)
Social Work: 1.00 CE (NYSED)

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Take the post-test

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Complete course evaluation

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Tools & Resources

MEMBERS ONLY locked

Care Management for Seriously Ill Patients: Addressing Gaps in Care: Key Takeaways

Last Updated: January 29, 2019

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.

MEMBERS ONLY locked

Care Management for Seriously Ill Patients: Addressing Gaps in Care: Open-Ended Questions

Last Updated: January 29, 2019

Specific phrases care managers can use to elicit information from patients or members about thier quality of life. Center to Advance Palliative Care, 2017.

MEMBERS ONLY locked

Pain Assessment Questions

Last Updated: January 29, 2019

Recommended assessment questions to typify pain and inform pain management for patients with serious illness. Center to Advance Palliative Care, 2015.

Zarit Burden Interview (ZBI-12)

Last Updated: January 29, 2019

A self-reported caregiver assessment.

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PHQ-4: Validated Screening Tool for Anxiety and Depression

Last Updated: January 29, 2019

Brief (4-question) screening tool for anxiety and depression.

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Revised Edmonton Symptom Assessment System (ESAS-r)

Last Updated: January 29, 2019

Assesses for nine symptoms experienced by patients with serious illness and quantifies their severity. Edmonton Zone Regional Palliative Care Program, 2010.

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NCCN Distress Thermometer

Last Updated: January 29, 2019

Assessment tool for symptom burden and impact on quality of life. National Comprehensive Cancer Network (NCCN), 2016.

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CAPC Recommended Curriculum for Care Managers

Last Updated: January 29, 2019

Suggested CAPC courses and tools for care managers. Center to Advance Palliative Care, 2018.

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CAPC Learning Pathway for Care Managers

Last Updated: January 29, 2019

Suggested CAPC courses and tools for care managers. Center to Advance Palliative Care, 2018.

download

Applying Motivational Interviewing Techniques to Palliative Care Communication

Last Updated: January 29, 2019

Communication techniques to elicit patient decisions, with the goal of supporting patient autonomy. Journal of Palliative Medicine, 2011.

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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.

Ankita Mehta, MD. Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai.

Contact information: For technical questions about online activity or continuing education credits, contact membership@capc.org or 212-201-2674.

Provided by the Icahn School of Medicine at Mount Sinai.

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