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Published on: January 20, 2019
Technology-driven interactive care management identifies and resolves more clinical issues than a claims-based
1Active Health Management, Inc., New York, New York 10016, USA. IverJuster@aol.com
Disease Management : DM
|June 22, 2005
Summary
Adding nurse interaction to physician alerts significantly improved chronic disease care. This combined approach identified more care gaps and increased issue resolution rates for patients compared to alerts alone.
Area of Science:
- Health Informatics
- Patient Care Management
- Clinical Issue Resolution
Background:
- Chronic disease patients often miss evidence-based care due to patient or physician factors.
- Physician-directed, claims-based alerts improve some clinical issues but leave many unresolved.
Purpose of the Study:
- To demonstrate that integrating nurse interaction with physician alerting systems uncovers additional care gaps.
- To increase successful alert resolution by communicating care gaps directly to patients.
Main Methods:
- Implemented an opt-in, nurse-managed pilot program for 205,463 members using a claims-based physician alerting system.
- Communicated claims-identified issues to enrollees and physicians; identified new issues via nurse-directed participant feedback.
- Tracked issue resolution using claims, pharmacy, and lab data over one year.
Main Results:
- Participants generated 80.8% more alerts (claims-based + participant-supplied data) than claims/pharmacy/lab data alone.
- Program participants showed a 20.9% higher rate of successful claims-identifiable issue resolution (32.1%) compared to non-participants (26.6%).
- Nurse-directed interaction significantly increased both identification of clinical issues and their resolution rates.
Conclusions:
- Care management technology enhanced by nurse-directed patient interaction improves clinical issue identification beyond claims-based alerts.
- Communicating specific issues to both patients and physicians significantly boosts the rate of issue resolution.
- This integrated approach offers a more effective strategy for managing chronic diseases and ensuring evidence-based care.
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