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J Gen Intern Med. 2018 Jan;33(1):26-33. doi: 10.1007/s11606-017-4200-1. Epub 2017 Oct 5.

What Do High-Risk Patients Value? Perspectives on a Care Management Program.

Ganguli I1,2, Orav EJ3,4,5, Weil E4,6, Ferris TG4,6, Vogeli C4,6.

Author information

1
Brigham and Women's Hospital, Boston, MA, USA. iganguli@bwh.harvard.edu.
2
Harvard Medical School, Boston, MA, USA. iganguli@bwh.harvard.edu.
3
Brigham and Women's Hospital, Boston, MA, USA.
4
Harvard Medical School, Boston, MA, USA.
5
Harvard T.H. Chan School of Public Health, Boston, MA, USA.
6
Massachusetts General Hospital, Boston, MA, USA.

Abstract

BACKGROUND:

There is growing interest in coordinating care for high-risk patients through care management programs despite inconsistent results on cost reduction. Early evidence suggests patient-centered benefits, but we know little about how participants engage with the programs and what aspects they value.

OBJECTIVE:

To explore care management program participants' awareness and perceived utility of program offerings.

DESIGN:

Cross-sectional telephone survey administered December 2015-January 2016.

PARTICIPANTS:

Patients enrolled in a Boston-area primary care-based care management program.

MAIN MEASURES:

Our main outcome was the number of topics in which patients reported having "very helpful" interactions with their care team in the past year. We analyzed awareness of one's care manager as an intermediate outcome, and then as a primary predictor of the main outcome, along with patient demographics, years in the program, attitudes, and worries as secondary predictors.

KEY RESULTS:

The survey response rate was 45.8% (n = 1220); non-respondents were similar to respondents. More respondents reported worrying about family (72.8%) or financial issues (52.5%) than about their own health (41.6%). Seventy-four percent reported care manager awareness, particularly women (OR 1.33, 95% CI 1.01-1.77) and those with more years in the program (OR 1.16, 95% CI 1.03-1.30). While interaction rates ranged from 19.8% to 72.4% across topics, 81.3% rated at least one interaction as very helpful. Those who were aware of their care manager reported very helpful interactions on more topics (OR 2.77, 95% CI 2.15-3.56), as did women (OR 1.25, 95% CI 1.00-1.55), younger respondents (OR 0.98 for older age, 95% CI 0.97-0.99), and those with higher risk scores (OR 1.04, 95% CI 1.02-1.06), preference for deferring treatment decisions to doctors (OR 2.00, 95% CI 1.60-2.50), and reported control over their health (OR 1.67, 95% CI 1.33-2.10).

CONCLUSIONS:

High-risk patients reported helpful interactions with their care team around medical and social determinants of health, particularly those who knew their care manager. Promoting care manager awareness may help participants make better use of the program.

KEYWORDS:

high cost patients; high-risk care management; patient-centered care; population health management

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