Perceived Impact of Care Managers' Work on Patient and Clinician Outcomes.
OBJECTIVE
The aim of this study is to assess the contributions of care management as perceived by care managers themselves.


METHODS
Focus groups and interviews with care managers who coordinate care for chronic obstructive pulmonary disease and congestive heart failure patients, as well as patients undergoing major surgery.


METHODS
We collected data in focus groups and interviews with 12 care managers working in the Keystone Beacon Community project, including 5 care managers working in hospitals, 2 employed in outpatient clinics and 4 telephoning discharged patients from a Transitions of Care (TOC) call center.


RESULTS
Inpatient care managers believe that (1) ensuring primary care provider follow-up, (2) coordinating appropriate services, (3) providing patient education, and (4) ensuring accurate medication reconciliation have the greatest impact on patient clinical outcomes. In contrast, outpatient and TOC care managers believe that (1) teaching patients the signs and symptoms of acute exacerbations and (2) building effective relationships with patients improve patient outcomes most. Some care management activities were perceived to have greater impact on patients with certain conditions (e.g., outpatient and TOC care managers saw effective relationships as having more impact on patients with COPD). All care managers believed that relationships with patients have the greatest impact on patient satisfaction, while the support they provide clinicians has the greatest impact on clinician satisfaction.


CONCLUSIONS
These findings may improve best practice for care managers by focusing interventions on the most effective activities for patients with specific medical conditions.
Center for Quality and Productivity Improvement, University of Wisconsin-Madison 1550 Engineering Drive, Madison, WI 53706 ; Department of Industrial and Systems Engineering, University of Wisconsin-Madison 1513 University Avenue, Madison, WI 53706.
Pascale
P
Carayon
Center for Quality and Productivity Improvement, University of Wisconsin-Madison 1550 Engineering Drive, Madison, WI 53706.
Ann Schoofs
AS
Hundt
Center for Quality and Productivity Improvement, University of Wisconsin-Madison 1550 Engineering Drive, Madison, WI 53706.
Peter
P
Hoonakker
Center for Quality and Productivity Improvement, University of Wisconsin-Madison 1550 Engineering Drive, Madison, WI 53706 ; Department of Industrial and Systems Engineering, University of Wisconsin-Madison 1513 University Avenue, Madison, WI 53706.
Sarah
S
Kianfar
Center for Quality and Productivity Improvement, University of Wisconsin-Madison 1550 Engineering Drive, Madison, WI 53706 ; Department of Industrial and Systems Engineering, University of Wisconsin-Madison 1513 University Avenue, Madison, WI 53706.
Bashar
B
Alyousef
Geisinger Health System 100 North Academy Avenue, Danville, PA 17822.
Doreen
D
Salek
Center for Quality and Productivity Improvement, University of Wisconsin-Madison 1550 Engineering Drive, Madison, WI 53706.
Randi
R
Cartmill
Geisinger Health System 100 North Academy Avenue, Danville, PA 17822.
James M
JM
Walker
Geisinger Health System 100 North Academy Avenue, Danville, PA 17822.
Janet
J
Tomcavage
care coordination; care manager; case management; emergency treatment; hospital readmission; patient admission