Background: Case managers are employed in medical homes to coordinate care for clinically complex patients.
Objective: To measure the association of patient perceptions of case manager performance with overall satisfaction and subsequent health care utilization.
Design: Retrospective cohort study.
Setting: Integrated health system in Pennsylvania.
Patients: Members of the health system-owned health plan who 1) received primary care in the health system's clinics, 2) were exposed to clinic-embedded case managers, and 3) completed a survey of satisfaction with care.
Measurements: Survey assessment of case manager performance and overall satisfaction with care and claims-based assessment of case manager performance and subsequent hospitalizations or emergency department visits. Survey measures were dichotomized into very good versus less than very good.
Results: A total of 1755 patients (44%) completed the survey and 1415 met study criteria. Survey respondents who reported very good ratings of case manager performance across all items had a higher probability of reporting very good overall satisfaction with care (92.2% vs. 62.5%; P < 0.001) and had a lower incidence of subsequent emergency department visits (incidence rate ratio, 0.79 [95% CI, 0.64 to 0.98]; P = 0.029) but not hospitalizations (incidence rate ratio, 0.92 [CI, 0.75 to 1.11]; P = 0.37) up to 2 years after the survey compared with survey respondents who reported less-than-very good case manager performance on 1 or more questions on the survey.
Limitations: Satisfaction data demonstrated substantial ceiling effects. Survey nonresponse may have introduced bias in the results.
Conclusion: Patients' favorable perceptions of case managers are associated with higher overall satisfaction with care and may lower risk for future acute care use.
Primary funding source: Robert Wood Johnson Foundation and the U.S. Department of Veterans Affairs.