AHIP AHM-540 問題集

質問 1：
One difference between outcomes research and clinical research is that outcomes research
A. gathers outcomes data from controlled clinical trials, whereas clinical research collects and analyzes clinical, financial, and administrative data
B. examines diseases and treatments in isolation, whereas clinical research considers the effects of changes in health status and quality of life
C. focuses on treatment effectiveness, whereas clinical research focuses on treatment efficacy
D. provides an absolute measure of treatment results, whereas clinical research provides a relative measure of results
正解：C

質問 2：
Nilay Sharma suffered a small wound while working in his yard and was taken to a local hospital for treatment. A triage nurse at the hospital evaluated Mr. Sharma's condition and directed him to an outpatient unit in the hospital where a physician assistant examined, cleaned, and sutured the wound. Mr. Sharma returned home following treatment. The care Mr. Sharma received at the hospital is an example of the type of care known as
A. emergency care
B. specialty referral
C. urgent care
D. primary prevention
正解：C

質問 3：
The following statement(s) can correctly be made about utilization guidelines:
1.When developing utilization guidelines, health plans balance evidence-based criteria with experience-based criteria
2.Utilization guidelines indicate when a UR nurse should refer a decision to a physician reviewer
A. Neither 1 nor 2
B. 2 only
C. Both 1 and 2
D. 1 only
正解：C

質問 4：
One way that health plans evaluate their UR programs is by monitoring utilization rates. By definition, utilization rates typically
A. indicate standard approaches to care for many common, uncomplicated healthcare services
B. report the number of times that a particular provider performs or recommends a service excluded from the benefit plan
C. indicate changes in the total amount of medical expenses or claim dollars paid for particular procedures
D. measure the number of services provided per 1,000 members per year
正解：D

質問 5：
Health plans have a specified number of working days to respond to Level One appeals, as stated by company policy or regulatory requirements. With regard to the timeframes for appeals, it is generally correct to say
1.That the typical timeframe requires a health plan to respond to appeals in fewer than 20 days
2.That the timeframe is accelerated for expedited appeals
3.That the review period begins when the appeal arrives at a health plan
A. 1 and 3 only
B. 1 and 2 only
C. 2 and 3 only
D. All of the above
正解：C

質問 6：
Various government and independent agencies have created tools to measure and report the quality of healthcare. One performance measurement tool that was developed by the Agency for Healthcare Research and Quality (AHRQ) is
A. CAHPS, which is a tool that measures consumer satisfaction with specific aspects of health plan services
B. HEDIS, which is a performance measurement tool that addresses both effectiveness of care and plan member satisfaction
C. the Health Plan Employer Data and Information Set (HEDIS@), which is a report card system for hospitals and long-term care facilities
D. the Consumer Assessment of Health Plans (CAHPS@), which was established to develop and implement a national strategy for quality measurement and reporting
正解：A