title: Care management dosage.
abstract: 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.
authors.affiliation: 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
authors.forename: David A
authors.initials: DA
authors.lastname: Dorr
authors.forename: Adam
authors.initials: A
authors.lastname: Wilcox
authors.forename: Spencer
authors.initials: S
authors.lastname: Jones
authors.forename: Laurie
authors.initials: L
authors.lastname: Burns
authors.forename: Steven M
authors.initials: SM
authors.lastname: Donnelly
authors.forename: Cherie P
authors.initials: CP
authors.lastname: Brunker
mesh_terms: 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
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D006454:Hemoglobins; C517652:hemoglobin A1c protein, human