Lindsay E. Jubelt, MD, MS *; Jove Graham, PhD; Daniel D. Maeng, PhD; Huilin Li, PhD; Andrew J. Epstein, PhD, MPP *; Joshua P. Metlay, MD, PhD
Financial Support: By the Robert Wood Johnson Foundation and the U.S. Department of Veterans Affairs. Dr. Metlay was supported by grant K24 AI073957 from the National Institutes of Health.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-3007.
Reproducible Research Statement:Study protocol: Not available. Statistical Code: Available from Dr. Jubelt (e-mail, firstname.lastname@example.org). Data set: Not available.
Requests for Single Reprints: Lindsay E. Jubelt, MD, MS, Department of Population Health, New York University School of Medicine, 1 Park Avenue, 10th Floor, New York, NY 10016; e-mail, email@example.com.
Current Author Addresses: Dr. Jubelt: Department of Population Health, New York University School of Medicine, 1 Park Avenue, 10th Floor, New York, NY 10016.
Dr. Graham: Geisinger Center for Health Research, 100 North Academy Avenue, Danville, PA 17822.
Dr. Maeng: Geisinger Health System, 100 North Academy Avenue, M.C. 44-00, Danville, PA 17822.
Dr. Li: Department of Population Health, New York University Langone Medical Center, 650 First Avenue, Room 547, New York, NY 10016.
Dr. Epstein: Perelman School of Medicine, University of Pennsylvania, 1001 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.
Dr. Metlay: Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114.
Author Contributions: Conception and design: L.E. Jubelt, J. Graham, J.P. Metlay.
Analysis and interpretation of the data: L.E. Jubelt, J. Graham, H. Li, A.J. Epstein, J.P. Metlay.
Drafting of the article: L.E. Jubelt, D.D. Maeng, J.P. Metlay.
Critical revision of the article for important intellectual content: L.E. Jubelt, J. Graham, D.D. Maeng, H. Li, A.J. Epstein, J.P. Metlay.
Final approval of the article: L.E. Jubelt, J. Graham, D.D. Maeng, H. Li, A.J. Epstein, J.P. Metlay.
Statistical expertise: L.E. Jubelt, J. Graham, H. Li, A.J. Epstein.
Obtaining of funding: L.E. Jubelt, J.P. Metlay.
Administrative, technical, or logistic support: L.E. Jubelt.
Collection and assembly of data: L.E. Jubelt, J. Graham, D.D. Maeng.
Case managers are employed in medical homes to coordinate care for clinically complex patients.
To measure the association of patient perceptions of case manager performance with overall satisfaction and subsequent health care utilization.
Retrospective cohort study.
Integrated health system in Pennsylvania.
Members of the health system–owned health plan who 1) received primary care in the health system's clinics, 2) were exposed to clinic-embedded case managers, and 3) completed a survey of satisfaction with care.
Survey assessment of case manager performance and overall satisfaction with care and claims-based assessment of case manager performance and subsequent hospitalizations or emergency department visits. Survey measures were dichotomized into very good versus less than very good.
A total of 1755 patients (44%) completed the survey and 1415 met study criteria. Survey respondents who reported very good ratings of case manager performance across all items had a higher probability of reporting very good overall satisfaction with care (92.2% vs. 62.5%; P < 0.001) and had a lower incidence of subsequent emergency department visits (incidence rate ratio, 0.79 [95% CI, 0.64 to 0.98]; P = 0.029) but not hospitalizations (incidence rate ratio, 0.92 [CI, 0.75 to 1.11]; P = 0.37) up to 2 years after the survey compared with survey respondents who reported less-than-very good case manager performance on 1 or more questions on the survey.
Satisfaction data demonstrated substantial ceiling effects. Survey nonresponse may have introduced bias in the results.
Patients' favorable perceptions of case managers are associated with higher overall satisfaction with care and may lower risk for future acute care use.
Robert Wood Johnson Foundation and the U.S. Department of Veterans Affairs.
Study flow diagram.
Steps in identifying the final sample for the satisfaction and utilization analyses for the study, including the number of nonreturned surveys and exclusion criteria. CM = case manager; ID = identification.
Table 1. Characteristics of Participants and Nonparticipants
Table 2. Distribution of Survey Responses for Case Manager and Overall Satisfaction Ratings
Table 3. Factors Associated With Probability of Very Good Overall Satisfaction With Care
Table 4. Factors Associated With Rate of Emergency Department Visits and Hospitalizations
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Jubelt LE, Graham J, Maeng DD, Li H, Epstein AJ, Metlay JP. Patient Ratings of Case Managers in a Medical Home: Associations With Patient Satisfaction and Health Care Utilization. Ann Intern Med. ;161:S59–S65. doi: 10.7326/M13-3007
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Published: Ann Intern Med. 2014;161(10_Supplement):S59-S65.
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