title: Clinical nurse specialist care managers' time commitments in a disease-management program for bipolar disorder.
abstract: OBJECTIVE
  As part of a cost-effectiveness analysis for Department of Veterans Affairs Cooperative Studies Program #430, 'Reducing the Efficacy-Effectiveness Gap in Bipolar Disorder,' we conducted a time and motion study to quantify the time psychiatric clinical nurse specialist (CNS) care managers spent providing care for patients.
  
  
  METHODS
  Clinical nurse specialist care managers completed activity logs in which they recorded time spent implementing the Bipolar Disorders Program (BDP) during a 1-week period in spring, summer, fall and winter over a 1-year period when caseloads were at steady state. Mean service time was estimated by use of univariate analysis of means and by multivariable regression analysis.
  
  
  RESULTS
  On average CNS care managers spent 40% of their clinical time in activities that typically are reimbursed (e.g. clinic visits) and spent the remaining 60% of their time in activities that are typically unreimbursed. Total clinic time increased as the number of visits per day increased; however, this increase got smaller with each additional visit per day.
  
  
  CONCLUSIONS
  As with other chronic illness management programs, CNS care managers expend a substantial portion of their clinical effort for the BDP in activities that are typically unreimbursed. Their activities have a fixed component per day as well as a component that systematically varies with the number of visits per day. These findings should be considered when costing out and disseminating psychiatric and other medical chronic illness management programs.
authors.affiliation: hlthsvrs@mail.med.upenn.edu
authors.forename: Henry A
authors.initials: HA
authors.lastname: Glick
authors.forename: Bruce
authors.initials: B
authors.lastname: Kinosian
authors.forename: Linda
authors.initials: L
authors.lastname: McBride
authors.forename: William O
authors.initials: WO
authors.lastname: Williford
authors.forename: Mark S
authors.initials: MS
authors.lastname: Bauer
mesh_terms: D001714:Bipolar Disorder / Q000451:nursing* / Q000628:therapy*; D019090:Case Management; D019468:Disease Management; D004282:Documentation / Q000379:methods; D006801:Humans; D009720:Nurse Clinicians; D016730:Program Development; D013997:Time Factors