Time Allocation and Caseload Capacity in Telephone Depression Care Management

Published In: The American Journal of Managed Care, v. 13, no. 12, Dec. 2007, p. 652-660

Posted on RAND.org on December 31, 2006

by Chuan-Fen Liu, John Fortney, Susan Vivell, Karen Vollen, William N. Raney, Barbara Revay, Maurilio Garcia-Maldonado, Jeffrey M. Pyne, Lisa V. Rubenstein, Edmund Chaney

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OBJECTIVE: To document time allocated to care management activities and care manager workload capacity using data collected for studies of telephone care management of depression. STUDY DESIGN: Cross-sectional, descriptive analysis of depression care manager (DCM) activities and workload in 2 collaborative depression care interventions (1 implementation study and 1 effectiveness study) at Department of Veterans Affairs primary care facilities. METHODS: Each intervention tracked specific care management activities for 4 weeks, recording the number of events for each activity type and length of time for each activity. Patient workload data were obtained from the patient tracking systems for the 2 projects. We calculated the average time for each activity type, the average total time required to complete an initial assessment call and follow-up call, and the maximum patient panel for both projects. RESULTS: The total time per successful initial assessment was 75 to 95 minutes, and the total time per successful follow-up call was 51 to 60 minutes, with more time spent on ancillary activities (precall preparation, postcall documentation, and provider communication) than on direct patient contact. A significant amount of time was spent in unsuccessful call attempts, requiring 9 to 11 minutes for each attempt. The maximum panel size per care manager per quarter was in the range of 143 to 165 patients. CONCLUSIONS: The study found similar DCM time allocations and panel sizes across 2 studies and 3 regions with full-time DCMs. Reductions in DCM time spent on ancillary activities may be achievable through improved informatics and other support for panel management.

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