Time allocation and caseload capacity in telephone depression care management.
OBJECTIVE
To document time allocated to care management activities and care manager workload capacity using data collected for studies of telephone care management of depression.


METHODS
Cross-sectional, descriptive analysis of depression care manager (DCM) activities and workload in 2 collaborative depression care interventions (1 implementation study and 1 effectiveness study) at Department of Veterans Affairs primary care facilities.


METHODS
Each intervention tracked specific care management activities for 4 weeks, recording the number of events for each activity type and length of time for each activity. Patient workload data were obtained from the patient tracking systems for the 2 projects. We calculated the average time for each activity type, the average total time required to complete an initial assessment call and follow-up call, and the maximum patient panel for both projects.


RESULTS
The total time per successful initial assessment was 75 to 95 minutes, and the total time per successful follow-up call was 51 to 60 minutes, with more time spent on ancillary activities (precall preparation, postcall documentation, and provider communication) than on direct patient contact. A significant amount of time was spent in unsuccessful call attempts, requiring 9 to 11 minutes for each attempt. The maximum panel size per care manager per quarter was in the range of 143 to 165 patients.


CONCLUSIONS
The study found similar DCM time allocations and panel sizes across 2 studies and 3 regions with full-time DCMs. Reductions in DCM time spent on ancillary activities may be achievable through improved informatics and other support for panel management.
Liu
Chuan-Fen
CF
VA Puget Sound Health Care System, Health Services Research & Development, 1100 Olive Way, Ste 1400, Seattle WA 98101, USA. chuan-fen.liu@med.va.gov
Fortney
John
J
Vivell
Susan
S
Vollen
Karen
K
Raney
William N
WN
Revay
Barbara
B
Garcia-Maldonado
Maurilio
M
Pyne
Jeffrey
J
Rubenstein
Lisa V
LV
Chaney
Edmund
E
D000554:Ambulatory Care Facilities; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000628:therapy*; D019468:Disease Management; D019317:Evidence-Based Medicine; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration / Q000706:statistics & numerical data; D013996:Time and Motion Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D016526:Workload