Care management involves a number of interrelated activities, including direct service, care delivery, and providing information to relevant providers. Patients, providers, and managers may place different relative value on these activities due to their different vantage points within the healthcare system. In this poster, we describe the relative value that key stakeholders, participating in a depression care quality improvement program utilizing care managers, place on these different activities.
As part of a larger study, Cost and Value of Evidence-based Solutions (COVES) for Depression, we assessed the relative value that different stakeholder groups place on seven core depression care manager (DCM) activities. Participants, located within three VISNs, included 26 VISN, VAMC, and clinic level managers, 30 primary care providers, 10 mental health providers, 4 DCMs, and 26 patients. Care manager activities included care delivery (patient assessment, treatment planning, progress monitoring), direct patient service (education, self-management support, general social support), and communication with providers. Staff participants ranked (1-7) activities according to relative importance to improving depression symptomatology. We also assessed the ranking that consumers placed on four of the components (progress monitoring, education, self-management support, and general social support).
Across clinical stakeholder groups, the majority (70.5%) ranked patient assessment as the most important component of care management. Although all of the DCMs identified patient assessment as the most important component, only 56.3% of managers and 78.6 % of providers did so. The second most commonly top ranked activity was patient education (11.4%). Of the four activities patients ranked, monitoring treatment progress and self-management support were the most important activities (36.8% and 26.3% respectively). When comparing patients, providers, and managers on just the 4 activities that patients were able to rank, 43.8% of managers and 64.3% of providers indicated that patient education was the most important, compared to only 15.8% of patients. Subsequent analysis will report differences amongst stakeholders by provider role (MH or PC providers).
Findings from this work will not only inform marketing associated with implementation efforts, it will also assist in tailoring collaborative care models for site specific needs.