Is the quality of case management in a medical home associated with patient satisfaction and healthcare utilization? 4_24_13 Lindsay Jubelt
Is the quality of case management in a medical homeassociated with patient satisfaction and healthcare utilization? Lindsay Jubelt, MD, Jove Graham, PhD, Daniel Maeng, PhD, Andrew Epstein, PhD, Josh Metlay, MD, PhDBackground Conceptual Model Methods (cont’d) Results (cont’d) • Data: We linked claims data from the Geisinger • A one point increase in case manager rating• In 2006, Geisinger Health System initiated a Health Plan from 2008-20011 to patient resulted in a 0.26 point increase in satisfaction medical home model, the Proven Health satisfaction data from the Geisinger Medical rating (p<0.001), and a one point increase in PCP Navigator (PHN). Home Patient Satisfaction Survey from 2009- rating resulted in a 0.57 increase in satisfaction• A central feature of the PHN was to assign 2012. The survey included six questions on rating (p<0.001). patients with complex medical needs to clinic- primary care provider (PCP) performance, four embedded case managers . questions on case manager performance, and• In traditional medical care models, stronger Beta Confidence two questions on satisfaction with care, all on 4- physician-patient relationships have a positive Coefficient Interval point Likert scales. For each survey, we impact on patient satisfaction with care and generated subscores for PCP performance, case Case Manager Rating 0.26 0.22-0.30 subsequent medical outcomes. manager performance and overall satisfaction• Despite the heightened role of case managers PCP Rating 0.57 0.38-0.83 based on the average ratings for questions in many medical homes, little is known about within each of these three domains. the relationship between case manager • Covariates: Patient characteristics, survey phase, performance, patient satisfaction with care, Conclusions and Next Steps case manager subscore, and PCP subscore. and future health behaviors. • Outcomes: Overall satisfaction with primary Objectives care. • Patient perceptions of their case manager and • Statistical analysis: We used multivariable primary care doctors are both independently 1. Measure the association between patient associated with overall satisfaction with care. regression to identify significant predictors of perceptions of case manager performance • The next steps in our analyses will focus on overall satisfaction, including case manager and and satisfaction with overall care examining the associations between patient PCP ratings. The unit of analysis was the individual patient. perceptions of case management and health care 2. Determine the association between patient utilization patterns. perceptions of case manager and PCP performance and subsequent health care Results utilization Policy Implications • Case manager ratings (mean=3.7, SD=0.4) , PCP Methods ratings (mean=3.9, SD=0.3) , and satisfaction • Given the known effect of primary care doctors ratings (mean=3.8, SD=0.4) did not differ on health care utilization, the independent and • Study design: Cross-sectional analysis significantly by age, sex, race, MEDai risk score, significant case management finding raises the of2,147 patients who received primary care or survey phase. possibility that case management may also in the Geisinger Health System and were • The above covariates were included in the impact patient health outcomes and health exposed to clinic-embedded case original model but later removed due to lack of behaviors. management. significance.