Care management dosage.
BACKGROUND
The care of patients with complex illnesses requires careful management, but systems of care management (CM) vary in their structure and effectiveness.


OBJECTIVE
To create a framework identifying components of broad-based CM interventions and validate the framework, including using this framework to evaluate the contribution of varying components on outcomes of patients with chronic illness.


METHODS
We create the framework using retrospective information about CM activities and services over 12 months and categorize it using cluster and factor analysis. We then validate this framework through content and criterion techniques. Content validity is assessed through a Delphi study and criterion validity through relationship of the dosage measures and patterns of care to process and outcomes measures.


METHODS
Patients with diabetes and/or cardiovascular disease receiving CM services in a model known as Care Management Plus implemented in primary care.


RESULTS
Six factors of CM activity were identified, including a single dosage summary measure and 5 separate patterns of care. Of these, the overall dosage summary measure, face-to-face time, duration of follow-up, and breadth of services were all related to improved processes for hemoglobin A1c and LDL testing and control. Brief intense patterns of care and high face-to-face care manager time were also related to improved outcomes.


CONCLUSIONS
Using this framework, we isolate components of a CM intervention directly related to improved process of care or patient outcomes. Current efforts to structure CM to include face-to-face time and multiple diseases are discussed.
Dorr
David A
DA
Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mailcode: BICC, Portland, OR 97239, USA. dorrd@ohsu.edu
Wilcox
Adam
A
Jones
Spencer
S
Burns
Laurie
L
Donnelly
Steven M
SM
Brunker
Cherie P
CP
D002318:Cardiovascular Diseases / Q000628:therapy*; D008078:Cholesterol, LDL / Q000032:analysis; D002908:Chronic Disease / Q000628:therapy; D016000:Cluster Analysis; D003920:Diabetes Mellitus / Q000628:therapy*; D005163:Factor Analysis, Statistical; D006442:Glycated Hemoglobin; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D010346:Patient Care Management / Q000458:organization & administration*; D011379:Prognosis; D012189:Retrospective Studies
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D006454:Hemoglobins; C517652:hemoglobin A1c protein, human