Use of Care Managemnet Tools for Patients with Chronic Conditions Varies Widely

Practice Size and Setting Related to Primary Care Physicians' Use of Care Management Tools; Solo and Smaller Practices Lag Larger Groups

News Release
Dec. 16, 2009

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Use of care management tools—such as group visits or patient registries—varies widely among primary care physicians whose practices care for patients with four common chronic conditions-asthma, diabetes, congestive heart failure and depression-according to a new national study released today by the Center for Studying Health System Change

Among primary care physicians caring for adult patients in 2008, 91 percent were in practices treating patients with asthma, diabetes, congestive heart failure and depression, according to the study funded by the Robert Wood Johnson Foundation (RWJF). Yet, these physicians’ use of care management tools varied widely, and interventions backed by the strongest evidence of effectiveness were used much less frequently.

Three-quarters of physicians reported offering patients written educational materials, but use of other tools for patient education and improved self-care was much lower, the study found. For example, half of physicians reported using nonphysician educators, one-third used nurse managers to coordinate care and one-fifth used group visits.

"The higher use of written patient education materials may reflect expediency rather than effectiveness—if you’re a busy physician, giving an educational pamphlet to your patient is quick and easy. But most researchers think it’s less powerful than other, more demanding interventions we found were used much less often.," said HSC Senior Researcher Emily Carrier, M.D., M.S.C.I., coauthor of the study with HSC Senior Researcher James Reschovsky, Ph.D.

Practice size and setting were strongly related to the likelihood that physicians used care management tools, with solo and smaller group practices least likely to use care management tools, according to the study.

"The findings suggest that, along with experimenting with financial incentives for primary care physicians to adopt care management tools, policy makers might consider developing community-level resources-such as nurse managers-that could be shared among smaller practices," Carrier said.

Based on HSC’s nationally representative 2008 Health Tracking Physician Survey, the study findings are detailed in a new HSC Issue Brief—Expectations Outpace Reality: Physicians’ Use of Care Management Tools for Patients with Chronic Conditions—available here.

Funded by RWJF, the survey includes responses from more than 4,700 physicians, and the response rate was 62 percent. The survey includes a subsample of 1,304 physicians who reported training in internal medicine or family practice, providing primary care for adults, and that their practice treats patients with diabetes, congestive heart failure, asthma and depression.

The survey asked physicians whether their practices used: written materials for patient education; nurse managers to coordinate care; nonphysician educators; group visits; reports for physicians on the quality of preventive care they deliver; reports for physicians on the quality of care they deliver to patients with chronic conditions; and patient registries.

Other key findings include:

• Physicians more uniformly used tools offering feedback on the quality of their care, which can help identify areas for improvement. About two-thirds of physicians reported receiving reports on the quality of their preventive and chronic care, and 40 percent used registries to identify patients with specific chronic conditions.
• Overall, 47 percent of physicians were in practices that used two or fewer of the seven care management tools, and 4 percent were in practices using six or seven care management tools.
• Physicians in larger groups were more likely to use nearly every type of care management tool than physicians in solo or two-physician practices. Likewise, physicians in group- or staff-model health maintenance organizations (HMOs) were the most likely to use all of the care management tools.
  For example, about one in 10 physicians in solo or two-physician practices reported using group visits, compared with about three in 10 physicians in group practices of 50 or more physicians, and about seven in 10 physicians in group/staff-model HMOs.
• Use of reports on the quality of preventive and chronic care varied less across practice settings. Eighty-six percent of physicians in group/staff HMOs received both types of feedback reports, compared with physicians in solo or two-physician practices where 63 percent received reports on preventive care and 67 percent received reports on chronic care.
• Among primary care physicians whose practices treated patients with asthma, diabetes, depression and congestive heart failure, most used care management tools for patients with some conditions but not others. Physicians using tools in their practices for patient education and improved self-care-written materials, nurse managers, nonphysician educators and group visits-were asked about which tools they used for which conditions. With the exception of written educational materials, less than 15 percent of physicians reported using any tool across all four of the chronic conditions.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded in part by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research.