Brigham and Women's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Gen Intern Med. 2018 Jan;33(1):26-33. doi: 10.1007/s11606-017-4200-1. Epub 2017 Oct 5.
There is growing interest in coordinating care for high-risk patients through care management programs despite inconsistent results on cost reduction. Early evidence suggests patient-centered benefits, but we know little about how participants engage with the programs and what aspects they value.
To explore care management program participants' awareness and perceived utility of program offerings.
Cross-sectional telephone survey administered December 2015-January 2016.
Patients enrolled in a Boston-area primary care-based care management program.
Our main outcome was the number of topics in which patients reported having "very helpful" interactions with their care team in the past year. We analyzed awareness of one's care manager as an intermediate outcome, and then as a primary predictor of the main outcome, along with patient demographics, years in the program, attitudes, and worries as secondary predictors.
The survey response rate was 45.8% (n = 1220); non-respondents were similar to respondents. More respondents reported worrying about family (72.8%) or financial issues (52.5%) than about their own health (41.6%). Seventy-four percent reported care manager awareness, particularly women (OR 1.33, 95% CI 1.01-1.77) and those with more years in the program (OR 1.16, 95% CI 1.03-1.30). While interaction rates ranged from 19.8% to 72.4% across topics, 81.3% rated at least one interaction as very helpful. Those who were aware of their care manager reported very helpful interactions on more topics (OR 2.77, 95% CI 2.15-3.56), as did women (OR 1.25, 95% CI 1.00-1.55), younger respondents (OR 0.98 for older age, 95% CI 0.97-0.99), and those with higher risk scores (OR 1.04, 95% CI 1.02-1.06), preference for deferring treatment decisions to doctors (OR 2.00, 95% CI 1.60-2.50), and reported control over their health (OR 1.67, 95% CI 1.33-2.10).
High-risk patients reported helpful interactions with their care team around medical and social determinants of health, particularly those who knew their care manager. Promoting care manager awareness may help participants make better use of the program.
尽管降低成本的效果不一致，但人们对通过护理管理计划协调高危患者的护理越来越感兴趣。早期证据表明以患者为中心的获益，但我们对参与者如何参与该计划以及他们重视哪些方面知之甚少。
探讨护理管理计划参与者对计划提供的服务的认知和感知效用。
2015 年 12 月至 2016 年 1 月进行的横断面电话调查。
参与波士顿地区基于初级保健的护理管理计划的患者。
我们的主要结果是患者报告在过去一年中与他们的护理团队在哪些主题上有“非常有帮助”的互动。我们将对护理经理的认知作为中间结果进行分析，然后将其作为主要结果的主要预测指标，同时将患者人口统计学，项目年限，态度和担忧作为次要预测指标。
调查回复率为 45.8%（n=1220）；未回复者与回复者相似。更多的受访者表示担心家庭（72.8%）或财务问题（52.5%），而不是自己的健康（41.6%）。74%的人报告了对护理经理的认识，尤其是女性（OR 1.33，95%CI 1.01-1.77）和在该项目中工作年限较长的人（OR 1.16，95%CI 1.03-1.30）。尽管各个主题的互动率从 19.8%到 72.4%不等，但有 81.3%的受访者对至少一次互动评价为非常有帮助。那些知道自己护理经理的人报告说，在更多主题上的互动非常有帮助（OR 2.77，95%CI 2.15-3.56），女性（OR 1.25，95%CI 1.00-1.55），年轻的受访者（OR 0.98 岁以上，95%CI 0.97-0.99），以及风险评分较高的受访者（OR 1.04，95%CI 1.02-1.06），更倾向于将治疗决策推迟给医生（OR 2.00，95%CI 1.60-2.50），并报告对自己的健康有控制感（OR 1.67，95%CI 1.33-2.10）。
高危患者报告在医疗和健康的社会决定因素方面与他们的护理团队有帮助的互动，特别是那些了解他们的护理经理的人。提高对护理经理的认识可能有助于参与者更好地利用该计划。
