title: Monitoring Resource Utilization in a Health Care Coordination Program.
abstract: OBJECTIVE
  This initial article describes the development of a health care coordination intervention and documentation system designed using the Agency for Healthcare Research and Quality (AHRQ) Care Coordination Atlas framework for Centers for Medicare & Medicaid-funded innovation project, Leveraging Information Technology to Guide High-Tech, High-Touch Care (LIGHT).
  
  
  METHODS
  The study occurred at an academic medical center that serves 114 counties. Twenty-five registered nurse care managers (NCMs) were hired to work with 137 providers in 10 family community and internal medicine clinics.
  
  
  METHODS
  Patients were allocated into one of the four tiers on the basis of their chronic medical conditions and health care utilization. Using a documentation system on the basis of the AHRQ domains developed for this study, time and touch data were calculated for 8,593 Medicare, Medicaid, or dual-eligible patients.
  
  
  RESULTS
  We discovered through the touch and time analysis that the majority of health care coordination activity occurred in the AHRQ domains of communication, assess needs and goals, and facilitate transitions, accounting for 79% of the NCM time and 61% of the touches. As expected, increasing tier levels resulted in increased use of NCM resources. Tier 3 accounted for roughly 16% of the patients and received 159 minutes/member (33% of total minutes), and Tier 4 accounted for 4% of patients and received 316 minutes/member (17% of all minutes). In contrast Tier 2, which did not require routine touches per protocol, had 5,507 patients (64%), and those patients received 5,246 hours of health care coordination, or 57 minutes/member, and took 48% of NCM time.
  
  
  CONCLUSIONS
  1. The AHRQ Care Coordination Atlas offered a systematic way to build a documentation system that allowed for the extraction of data that was used to calculate the amount of time and the number of touches that NCMs delivered per member. 2. Using a framework to systematically guide the work of health care coordination helped NCMs to think strategically about the care being delivered, and has implications for improving coordination of care. 3. For the purpose of reimbursement and communication with payers about quality metrics, it is vital that the type of touches and amount of time spent in delivering care coordination be documented in a manner that can be easily retrieved to guide practice decisions.
authors.affiliation: Lori L. Popejoy, PhD, APRN, GCNS-BC, is an Associate Professor in the Sinclair School of Nursing, University of Missouri, Columbia. She is Co-Director and co-investigator for the Leveraging Information Technology to Guide High-Touch, High-Tech (LIGHT2) care project. Dr. Popejoy's area of research and practice is care coordination for older adults. Julie Jaddoo, BSc, CIS, is a Health Information Analyst with the LIGHT2 project. She started working with the project in May 2014. She will be completing a Master in Health Informatics in May 2015. She is a Health Information Analyst for the LIGHT2 project described in this paper. Jan Sherman, PhD, APRN, NNP-BC, is an Associate Teaching Professor in the Sinclair School of Nursing, University of Missouri, Columbia. She was the Coordinator for Curriculum Development and Training for the LIGHT2 project described in this paper. Dr. Sherman's area of research and practice is the neonatal population. Christopher Howk, BA, is a consultant at Cerner Corporation working with the Tiger Institute in Columbia, Missouri to deliver the High-Tech components of the LIGHT2 project described in the paper. His main focus on the project was on technical reporting and quality improvement. Raymond Nguyen, MS, is a graduate student in the Department of Mathematics at the University of Missouri, Columbia where he is currently pursuing a PhD. He was a Health Information Analyst for the LIGHT2 project described in this paper. Jerry C. Parker, PhD, is the Associate Dean for Research and Co-Director of the MU Institute for Clinical and Translational Science at the University of Missouri School of Medicine. He is the Principal Investigator and Director of LIGHT2.
authors.forename: Lori L
authors.initials: LL
authors.lastname: Popejoy
authors.forename: Julie
authors.initials: J
authors.lastname: Jaddoo
authors.forename: Jan
authors.initials: J
authors.lastname: Sherman
authors.forename: Christopher
authors.initials: C
authors.lastname: Howk
authors.forename: Raymond
authors.initials: R
authors.lastname: Nguyen
authors.forename: Jerry C
authors.initials: JC
authors.lastname: Parker
mesh_terms: D019090:Case Management; D003142:Communication; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards*; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans