title: Clinician considerations when selecting high-risk patients for care management.
abstract: OBJECTIVE
  Hybrid approaches to case finding show promise as a method to increase the success of care management programs (CMPs). A large healthcare system implemented a hybrid approach in which clinicians review algorithm-generated lists of potential high-risk patients within their practice and select the patients most appropriate for the CMP. We sought to understand the criteria clinicians used when selecting patients.
  
  
  METHODS
  We conducted 20 semi-structured interviews with a convenience sample of primary care clinicians and their care managers from a diverse set of practices.
  
  
  METHODS
  Two independent reviewers thematically coded interview responses through an iterative process.
  
  
  RESULTS
  In addition to clinical need (eg, disease severity or multiple comorbidities), interviewees considered a number of nonclinical patient characteristics that they felt placed patients at risk for suboptimal healthcare utilization and poor adherence. These include patients' predisposing (eg, health literacy or navigation challenges, physical vulnerabilities, insight regarding their health) and enabling characteristics (eg, social and home environment, coping skills, financial resources). Interviewees also considered patients' existing linkages with the health system and whether other clinicians were already meeting a patient's care needs.
  
  
  CONCLUSIONS
  In selecting patients for a CMP, clinicians considered patient characteristics that are not easily captured in standard clinical and administrative data. A hybrid approach to case finding concentrates clinician review on patients who meet standard clinical and healthcare utilization criteria, and allows clinicians to incorporate knowledge of patients' predisposing and enabling characteristics that are not readily maintained in clinical data.
authors.forename: Vivian
authors.initials: V
authors.lastname: Haime
authors.forename: Clemens
authors.initials: C
authors.lastname: Hong
authors.forename: Laura
authors.initials: L
authors.lastname: Mandel
authors.forename: Namita
authors.initials: N
authors.lastname: Mohta
authors.forename: Lisa I
authors.initials: LI
authors.lastname: Iezzoni
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Ferris
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St, 9th Fl, Boston, MA 02114. E-mail: cvogeli@mgh.harvard.edu.
authors.forename: Christine
authors.initials: C
authors.lastname: Vogeli
mesh_terms: D000223:Adaptation, Psychological; D002908:Chronic Disease / Q000628:therapy*; D015897:Comorbidity; D003657:Decision Making; D005191:Family Characteristics; D057220:Health Literacy; D006801:Humans; D007407:Interviews as Topic; D008404:Massachusetts; D010346:Patient Care Management / Q000458:organization & administration / Q000592:standards*; D018579:Patient Selection; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards; D012720:Severity of Illness Index; D012931:Social Environment