Patient ratings of case managers in a medical home: associations with patient satisfaction and health care utilization.
BACKGROUND
Case managers are employed in medical homes to coordinate care for clinically complex patients.


OBJECTIVE
To measure the association of patient perceptions of case manager performance with overall satisfaction and subsequent health care utilization.


METHODS
Retrospective cohort study.


METHODS
Integrated health system in Pennsylvania.


METHODS
Members of the health system-owned health plan who 1) received primary care in the health system's clinics, 2) were exposed to clinic-embedded case managers, and 3) completed a survey of satisfaction with care.


METHODS
Survey assessment of case manager performance and overall satisfaction with care and claims-based assessment of case manager performance and subsequent hospitalizations or emergency department visits. Survey measures were dichotomized into very good versus less than very good.


RESULTS
A total of 1755 patients (44%) completed the survey and 1415 met study criteria. Survey respondents who reported very good ratings of case manager performance across all items had a higher probability of reporting very good overall satisfaction with care (92.2% vs. 62.5%; P < 0.001) and had a lower incidence of subsequent emergency department visits (incidence rate ratio, 0.79 [95% CI, 0.64 to 0.98]; P = 0.029) but not hospitalizations (incidence rate ratio, 0.92 [CI, 0.75 to 1.11]; P = 0.37) up to 2 years after the survey compared with survey respondents who reported less-than-very good case manager performance on 1 or more questions on the survey.


CONCLUSIONS
Satisfaction data demonstrated substantial ceiling effects. Survey nonresponse may have introduced bias in the results.


CONCLUSIONS
Patients' favorable perceptions of case managers are associated with higher overall satisfaction with care and may lower risk for future acute care use.


BACKGROUND
Robert Wood Johnson Foundation and the U.S. Department of Veterans Affairs.
Lindsay E
LE
Jubelt
Jove
J
Graham
Daniel D
DD
Maeng
Huilin
H
Li
Andrew J
AJ
Epstein
Joshua P
JP
Metlay
D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management / Q000592:standards*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000592:standards*; D010414:Pennsylvania; D012189:Retrospective Studies