Which Complex Patients Should Be Referred for Intensive Care Management? A Mixed-Methods Analysis
Maria E Garcia1, Connie S Uratsu2, Julie Sandoval-Perry3
1Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California, USA.
Journal of General Internal Medicine
|May 26, 2018
Summary
Identifying suitable patients for intensive care management is crucial. Many complex patients aren't ideal candidates, and current records miss key social and motivational factors.
Area of Science:
- Health Services Research
- Patient Care Management
Background:
- A significant portion of healthcare expenditures is attributed to a small group of medically and socially complex patients.
- Identifying which of these complex patients benefit most from intensive care management remains a challenge.
Purpose of the Study:
- To identify factors that best predict which complex patients are most suitable for intensive care management.
Main Methods:
- A mixed-methods study involving 35 care managers (CMs) who categorized 1178 patients.
- CMs reviewed patient records and categorized individuals as 'good candidates,' 'not needing' care management, or 'needing more' intensive support.
- Semi-structured interviews were conducted to understand the rationale behind these categorizations.
Main Results:
- Only 62% of referred patients were deemed 'good candidates' for intensive care management.
- Good candidates were older, prescribed more medications, and had more outpatient visits compared to other groups.
- Electronic medical record data predicted 'good candidate' status with a c-statistic of 0.75, but qualitative themes highlighted social support, motivation, and life changes as crucial factors.
Conclusions:
- Many patients identified as complex may not be appropriate for intensive care management.
- Current electronic medical records lack crucial data on social support, patient motivation, and recent life events.
- Systematically collecting information on these factors could improve the identification of patients who will benefit most from care management programs.
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