Care manager, older adult, and caregiver perspectives on co-occurring care management among high-need older adults.
care coordination
care management
collaboration
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
revised:
23
06
2023
received:
17
04
2023
accepted:
05
07
2023
pubmed:
4
8
2023
medline:
4
8
2023
entrez:
4
8
2023
Statut:
ppublish
Résumé
Care management programs are widely used to improve care coordination and management of chronic conditions for high-need older adults. With many care management programs targeting a small number of people, high-need older adults may receive services from more than one care management program (co-occurring care management), the implications of which are unknown. We conducted semi-structured interviews with 37 care managers, 15 older adults, and 13 caregivers, who were recruited through an urban academic medical center and a large rural health system in Maryland. We analyzed interview transcripts using qualitative content analysis with the aim of understanding contributors to, implications of, and strategies to manage co-occurring care management among high-need older adults. Contributors to co-occurring care management included siloed programs due to program-specific financial incentives and inability to easily identify other involved care managers, and the complex needs of the enrolled older adult population, which motivated involvement of more than one program. Implications of co-occurring care management included older adults and caregivers feeling cared for and safe when they had multiple care management programs involved and reporting value in their relationships with care managers. Older adults were identified as having greater access to resources and improved care when care manager roles were aligned in a complementary way; however, misaligned roles posed the potential for confusion about care manager accountability for tasks and resulted in frustration and lack of follow-through. Strategies for managing co-occurring care management included alignment of care manager roles through communication and negotiation and older adults and caregivers identifying and relying on a single care manager with whom they had the strongest relationship. Initiatives that clarify strengthen the relationship between care managers and older adults, increase care manager visibility, and facilitate communication across care managers may help foster collaboration.
Sections du résumé
BACKGROUND
BACKGROUND
Care management programs are widely used to improve care coordination and management of chronic conditions for high-need older adults. With many care management programs targeting a small number of people, high-need older adults may receive services from more than one care management program (co-occurring care management), the implications of which are unknown.
METHODS
METHODS
We conducted semi-structured interviews with 37 care managers, 15 older adults, and 13 caregivers, who were recruited through an urban academic medical center and a large rural health system in Maryland. We analyzed interview transcripts using qualitative content analysis with the aim of understanding contributors to, implications of, and strategies to manage co-occurring care management among high-need older adults.
RESULTS
RESULTS
Contributors to co-occurring care management included siloed programs due to program-specific financial incentives and inability to easily identify other involved care managers, and the complex needs of the enrolled older adult population, which motivated involvement of more than one program. Implications of co-occurring care management included older adults and caregivers feeling cared for and safe when they had multiple care management programs involved and reporting value in their relationships with care managers. Older adults were identified as having greater access to resources and improved care when care manager roles were aligned in a complementary way; however, misaligned roles posed the potential for confusion about care manager accountability for tasks and resulted in frustration and lack of follow-through. Strategies for managing co-occurring care management included alignment of care manager roles through communication and negotiation and older adults and caregivers identifying and relying on a single care manager with whom they had the strongest relationship.
CONCLUSIONS
CONCLUSIONS
Initiatives that clarify strengthen the relationship between care managers and older adults, increase care manager visibility, and facilitate communication across care managers may help foster collaboration.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3424-3434Subventions
Organisme : NIA NIH HHS
ID : K23AG072037
Pays : United States
Organisme : NIA NIH HHS
ID : K24AG056578
Pays : United States
Organisme : NIA NIH HHS
ID : L30 AG064736
Pays : United States
Organisme : NIA NIH HHS
ID : R03AG060170
Pays : United States
Organisme : NIA NIH HHS
ID : R35AG072310
Pays : United States
Organisme : NIA NIH HHS
ID : T35AG026758
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR003098
Pays : United States
Organisme : NIA NIH HHS
ID : K23AG072037
Pays : United States
Organisme : NIA NIH HHS
ID : K24AG056578
Pays : United States
Organisme : NIA NIH HHS
ID : L30 AG064736
Pays : United States
Organisme : NIA NIH HHS
ID : R03AG060170
Pays : United States
Organisme : NIA NIH HHS
ID : R35AG072310
Pays : United States
Organisme : NIA NIH HHS
ID : T35AG026758
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR003098
Pays : United States
Informations de copyright
© 2023 The American Geriatrics Society.
Références
Donelan K, Barreto EA, Michael CU, Nordby P, Smith M, Metlay JP. Variability in care management programs in Medicare ACOs: a survey of medical directors. J Gen Intern Med. 2018;33(12):2043-2045. doi:10.1007/s11606-018-4609-1
Hsu J, Price M, Vogeli C, et al. Bending the spending curve by altering care delivery patterns: the role of care management within a pioneer ACO. Health Aff. 2017;36(5):876-884. doi:10.1377/hlthaff.2016.0922
Hayes SL, Salzberg CA, McCarthy D, et al. High-need, high-cost patients: who are they and how do they use health care? A population-based comparison of demographics, health care use, and expenditures. Issue Brief (Commonw Fund). 2016;26:1-14.
Blumenthal D, Abrams MK. Tailoring complex care management for high-need, high-cost patients. JAMA. 2016;316(16):1657-1658. doi:10.1001/jama.2016.12388
Goodell S, Bodenheimer T, Berry-millett R. Care management of patients with complex health care needs. Synth Proj Res Synth Rep. 2009;19:52372.
Center for Health Care Strategies. Care management definition and framework. Published 2007. Accessed November 9, 2017. https://www.chcs.org/media/Care_Management_Framework.pdf
Brown RS, Peikes D, Peterson G, Schore J, Razafindrakoto CM. Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Health Aff (Millwood). 2012;31(6):1156-1166. doi:10.1377/hlthaff.2012.0393
Kelly KJ, Doucet S, Luke A. Exploring the roles, functions, and background of patient navigators and case managers: a scoping review. Int J Nurs Stud. 2019;98:27-47. doi:10.1016/j.ijnurstu.2019.05.016
Burwell SM. Setting value-based payment goals-HHS efforts to improve U.S. health care. N Engl J Med. 2015;372(10):897-899. doi:10.1056/NEJMp1500445
Zulman DM, Pal Chee C, Ezeji-Okoye SC, et al. Effect of an intensive outpatient program to augment primary care for high-need veterans affairs patients. JAMA Intern Med. 2017;177(2):166-175. doi:10.1001/jamainternmed.2016.8021
Anderson GF, Ballreich J, Bleich S, et al. Attributes common to programs that successfully treat high-need, high-cost individuals. Am J Manag Care. 2015;21(11):e597-e600.
Wiley JA, Rittenhouse DR, Shortell SM, et al. Managing chronic illness: physician practices increased the use of care management and medical home processes. Health Aff (Millwood). 2015;34(1):78-86. doi:10.1377/hlthaff.2014.0404
Bishop TF, Ramsay PP, Casalino LP, Bao Y, Pincus HA. Care management processes used less often for depression than for other chronic conditions in US primary care practices. Health Aff. 2016;35(3):394-400. doi:10.1377/hlthaff.2015.1068
Gallagher NA, Fox D, Dawson C, Williams B. Improving care transitions: complex high-utilizing patient experiences guide reform. Am J Manag Care. 2017;23(10):e347-e352.
Hardin L, Kilian A, Spykerman K. Competing health care systems and complex patients: an inter-professional collaboration to improve outcomes and reduce health care costs. J Interprofessional Educ Pract. 2017;7:5-10. doi:10.1016/j.xjep.2017.01.002
US Department of Health and Human Services. Recommendations for case management collaboration and coordination in federally funded HIV/AIDS programs: a coordinated & collaborative case management environment for the client. Published online 2008.
Span P. The tangle of coordinated health care. The New York Times. Published April 14, 2015. Accessed August 6, 2017. https://www.nytimes.com/2015/04/14/health/the-tangle-of-coordinated-health-care.html?_r=1
Rich EC, Lipson D, Libersky J, Peikes DN, Parchman ML. Organizing care for complex patients in the patient-centered medical home. Ann Fam Med. 2012;10(1):60-62. doi:10.1370/afm.1351
Holtrop JS, Ruland S, Diaz S, Morrato EH, Jones E. Using social network analysis to examine the effect of care management structure on chronic disease management communication within primary care. J Gen Intern Med. 2018;33(5):612-620. doi:10.1007/s11606-017-4247-z
McBrien KA, Ivers N, Barnieh L, et al. Patient navigators for people with chronic disease: a systematic review. PloS One. 2018;13(2):e0191980. doi:10.1371/journal.pone.0191980
Wakefield BJ, Boren SA, Groves PS, Conn VS. Heart failure care management programs: a review of study interventions and meta-analysis of outcomes. J Cardiovasc Nurs. 2013;28(1):8-19. doi:10.1097/JCN.0b013e318239f9e1
The Maryland Health Services Cost Review Commission. HSCRC-DHMH regional partnerships. Published 2015. Accessed September 18, 2017. http://hscrc.maryland.gov/Pages/regional-partnerships.aspx
Ahmed OI. Disease management, case management, care management, and care coordination: a framework and a brief manual for care programs and staff. Prof Case Manag. 2016;21(3):137-146. doi:10.1097/NCM.0000000000000147
Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015;42(5):533-544. doi:10.1007/s10488-013-0528-y
The Maryland Health Services Cost Review Commission. Maryland's all-payer model care redesign programs. Published 2016. Accessed October 6, 2017. http://mhaonline.org/docs/default-source/advocacy/regulatory/hscrc/documents-for-ceo-checklist/care-redesign-amendmentff49b55c78366c709642ff00005f0421.pdf?sfvrsn=2
Crabtree B, Miller W. Doing Qualitative Research. 2nd ed. Sage Publications Sage CA; 1999.
QSR International Pty Ltd. NVivo. 2020.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-1288.
Boeije H. A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual Quant. 2002;36(4):391-409. doi:10.1023/A:1020909529486
Microsoft Corporation. Microsoft Excel. 2019.
O'Malley ASO, Peikes D, Wilson C, Gaddes R, Peebles V. Patients' perspectives of care management: a qualitative study. Am J Manag Care. 2017;23(11):684-689.
Lee Y, Kasper D. Assessment of medical care by elderly people: general satisfaction and physician quality. Health Serv Res. 1998;32(6):741.
Cudjoe TKM, Roth DL, Szanton SL, Wolff JL, Boyd CM, Thorpe RJ. The epidemiology of social isolation: National Health & Aging Trends Study. J Gerontol B Psychol Sci Soc Sci. 2020;75(1):107-113.
Kasper JD, Freedman VA, Spillman BC, Wolff JL. The disproportionate impact of dementia on family and unpaid caregiving to older adults. Health Aff. 2015;34(10):1642-1649. doi:10.1377/hlthaff.2015.0536