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PERCEIVED IMPACT OF CARE MANAGERS’ WORK ON PATIENT AND CLINICIAN OUTCOMES

Pascale Carayon, Ann Schoofs Hundt, Peter Hoonakker, Sarah Kianfar, Bashar Alyousef, Doreen Salek, Randi S Cartmill, James M Walker, Janet Tomcavage

Abstract


Objectives: The aim of this study is to assess the contributions of care management as perceived by care managers themselves.

Study Design: Focus groups and interviews with care managers who coordinate care for chronic obstructive pulmonary disease and congestive heart failure patients, as well as patients undergoing major surgery.

Methods: We collected data in focus groups and interviews with 12 care managers working in the Keystone Beacon Community project, including 5 care managers working in hospitals, 2 employed in outpatient clinics and 4 telephoning discharged patients from a Transitions of Care (TOC) call center.

Results: Inpatient care managers believe that (1) ensuring primary care provider follow-up, (2) coordinating appropriate services, (3) providing patient education, and (4) ensuring accurate medication reconciliation have the greatest impact on patient clinical outcomes. In contrast, outpatient and TOC care managers believe that (1) teaching patients the signs and symptoms of acute exacerbations and (2) building effective relationships with patients improve patient outcomes most. Some care management activities were perceived to have greater impact on patients with certain conditions (e.g., outpatient and TOC care managers saw effective relationships as having more impact on patients with COPD). All care managers believed that relationships with patients have the greatest impact on patient satisfaction, while the support they provide clinicians has the greatest impact on clinician satisfaction.

Conclusions: These findings may improve best practice for care managers by focusing interventions on the most effective activities for patients with specific medical conditions.

Keywords


care manager; care coordination; case management; emergency treatment; hospital readmission; patient admission

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References


O'Malley, A.S. (2011). Tapping the unmet potential of health information technology. New England Journal of Medicine 364 (12) 1090-1091.

Jencks, S.F., Williams, M.V. & Coleman, E.A. (2009). Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine 360 (14) 1418-1428.

Stange, K.C., Nutting, P.A., Miller, W.L., Jaen, C.R., Crabtree, B.F., Flocke, S.A. & Gill, J.M. (2010). Defining and measuring the patient-centered medical home. Journal of General Internal Medicine 25 (6) 601-612.

Gilfillan, R.J., Tomcavage, J., Rosenthal, M.B., Davis, D.E., Graham, J., Roy, J.A., Pierdon, S.B., Bloom, F.R. Jnr., Graf, T.R., Goldman, R., Weikel, K.M., Hamory, B.H., Paulus, R.A. & Steele, G.D. Jnr. (2010).Value and the medical home: effects of transformed primary care. American Journal of Managed Care 16 (8) 607-614.

Taylor, E.F., Machta, R.M., Meyers, D.S., Genevro, J. & Peikes, D.N. (2013). Enhancing the primary care team to provide redesigned care: The roles of practice facilitators and care managers. Annals of Family Medicine 11 (1) 80-83.

McDonald, K.M., Schultz, E., Albin, L., Pineda, N., Lonhart, J., Sundaram, V., Smith-Spangler, C., Brustrom, J. & Malcolm, E. (2010). Care Coordination Measures Atlas. Rockville, MD: Agency for Healthcare Research and Quality, Contract No.: AHRQ Publication No. 11-0023-EF.

Harrison, P.L., Hara, P.A., Pope, J.E., Young, M.C. & Rula, E.Y. (2011). The impact of postdischarge telephonic follow-up on hospital readmissions. Population Health Management 14 (1) 27-32.

Steele, G.D., Haynes, J.A., Davis, D.E., Tomcavage, J., Stewart, W.F., Graf, T.R., Paulus, R.A., Weikel, K. & Shikles, J. (2010). How Geisinger's advanced medical home model argues the case for rapid-cycle innovation. Health Affairs 29 (11) 2047-2053.

Boult, C., Reider, L., Leff, B., Frick, K.D., Boyd, C.M., Wolff, J.L., Frey, K., Karm, L., Wegener, S.T., Mroz, T. & Scharfstein, D.O. (2011). The effect of guided care teams on the use of health services: Results from a cluster-randomized controlled trial. Archives of Internal Medicine 171 (5) 460-466.

Oliva, N.L. (2010). A closer look at nurse case management of community-dwelling older adults: Observations from a longitudinal study of care coordination in the chronically Ill. Professional Case Management 15 (2) 90-100.

Maliski, S.L., Clerkin, B. & Litwin, M.S. (2004). Describing a nurse case manager intervention to empower low-income men with prostate cancer. Oncology Nursing Forum 31 (1) 57-64.

Brown, R.S., Peikes, D., Peterson, G., Schore, J. & Razafindrakoto, C.M. (2012). Six features of medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Health Affairs 31 (6) 1156-1166.

Hoonakker, P.L.T., Carayon, P., Kern, L., et al. (2013). Inside the Black Box: What do inpatient case managers do? 2013 Symposium on Human Factors and Ergonomics in Health Care; March 11-13, 2013; Baltimore, MD2013, USA.

Hansen, L.O., Young, R.S., Hinami, K., Leung, A. & Williams, M.V. (2011). Interventions to reduce 30-day rehospitalization: A systematic review. Annals of Internal Medicine 155 (8) 520-528.

Carayon, P. (2009). The Balance Theory and the work system model... Twenty years later. International Journal of Human-Computer Interaction 25 (5) 313-327.

Carayon, P. & Smith, M.J. (2000). Work organization and ergonomics. Applied Ergonomics 31, 649-662.

Smith, M.J. & Carayon-Sainfort, P. (1989). A balance theory of job design for stress reduction. International Journal of Industrial Ergonomics 4 (1) 67-79.

Carayon, P., Hundt, A.S., Karsh, B-T., Gurses, AP., Alvarado, C.J., Smith, M. & Brennan, P.F. (2006). Work system design for patient safety: The SEIPS model. Quality & Safety in Health Care 15 (Supplement 1) i50-i58.

Carayon, P., Alyousef, B., Hoonakker, P., Hundt, A.S., Cartmill, R., Tomcavage, J., Hassoi, A., Chaundy, K., Larson, S., Younkin, J. & Walker, J. (2012). Challenges to care coordination posed by the use of multiple health IT applications. Work: Journal of Prevention, Assessment and Rehabilitation 41, 4468-4473.

van Walraven, C., Oake, N., Jennings, A. & Forster, A.J. (2010). The association between continuity of care and outcomes: A systematic and critical review. Journal of Evaluation in Clinical Practice 16 (5) 947-956.

Rudin, R.S. & Bates, D.W. (2014). Let the left hand know what the right is doing: A vision for care coordination and electronic health records. Journal of the American Medical Informatics Association 21 (1) 13-16.

Hansen, L.O., Young, R.S., Hinami, K., Leung, A. & Williams, M.V. (2011). Interventions to reduce 30-day rehospitalization: A systematic review. Annals of Internal Medicine 155 (8) 520-528.

Cramm, J.M. & Nieboer, A.P. (2012). Relational coordination promotes quality of chronic care delivery in Dutch disease-management programs. Health Care Management Review 37 (4) 301-309.




DOI: http://dx.doi.org/10.5750/ejpch.v3i2.903

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