Embedding care management in the medical home: a case study.
INTRODUCTION
Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach.


METHODS
A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff.


RESULTS
A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily via face-to-face, telephone, or electronic means, primarily for facilitating referrals for behavioral health services and assistance with financial and social and community-based resources. Trend line suggests an absolute decrease of 8 emergency department visits per month for recipients of care management services and an absolute decrease of 7.5 inpatient admissions per month during the initial 2-year implementation period.


DISCUSSION
An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.
['Daaleman|Timothy P|TP|', 'Hay|Sherry|S|', 'Prentice|Amy|A|', 'Gwynne|Mark D|MD|']
D000328:Adult D019033:Delivery of Health Care, Integrated D004636:Emergency Service, Hospital D005260:Female D006801:Humans D007400:Interprofessional Relations D008297:Male D009657:North Carolina D009735:Nursing Homes D019982:Organizational Case Studies D010346:Patient Care Management D018802:Patient-Centered Care D058996:Quality Improvement
care management medical home primary care implementation quality improvement