Abstract：
BACKGROUND: Many patients offered case management services to address their health and social needs choose not to engage. Factors that drive engagement remain unclear. We sought to understand patient characteristics associated with engagement in a social needs case management program and variability by case manager.
METHODS: Between August 2017 and February 2021, 43,347 Medicaid beneficiaries with an elevated risk of hospital or emergency department use were offered case management in Contra Costa County, California. Results were analyzed in 2022 using descriptive statistics and multilevel logistic regression models to examine 1) associations between patient engagement and patient characteristics and 2) variation in engagement attributable to case managers. Engagement was defined as responding to case manager outreach and documentation of at least 1 topic to mutually address. A sensitivity analysis was performed by stratifying the pre-COVID-19 and COVID-19 cohorts.
RESULTS: A total of 16,811 (39%) of eligible patients engaged. Adjusted analyses indicate associations between higher patient engagement and female gender, age 40 and over, Black/African American race, Hispanic/Latino ethnicity, history of homelessness, and a medical history of certain chronic conditions and depressive disorder. The intraclass correlation coefficient indicates that 6% of the variation in engagement was explained at the case manager level.
CONCLUSIONS: Medicaid patients with a history of housing instability and specific medical conditions were more likely to enroll in case management services, consistent with prior evidence that patients with greater need are more receptive to assistance. Case managers accounted for a small percentage of variation in patient engagement.
METHODS: Between August 2017 and February 2021, 43,347 Medicaid beneficiaries with an elevated risk of hospital or emergency department use were offered case management in Contra Costa County, California. Results were analyzed in 2022 using descriptive statistics and multilevel logistic regression models to examine 1) associations between patient engagement and patient characteristics and 2) variation in engagement attributable to case managers. Engagement was defined as responding to case manager outreach and documentation of at least 1 topic to mutually address. A sensitivity analysis was performed by stratifying the pre-COVID-19 and COVID-19 cohorts.
RESULTS: A total of 16,811 (39%) of eligible patients engaged. Adjusted analyses indicate associations between higher patient engagement and female gender, age 40 and over, Black/African American race, Hispanic/Latino ethnicity, history of homelessness, and a medical history of certain chronic conditions and depressive disorder. The intraclass correlation coefficient indicates that 6% of the variation in engagement was explained at the case manager level.
CONCLUSIONS: Medicaid patients with a history of housing instability and specific medical conditions were more likely to enroll in case management services, consistent with prior evidence that patients with greater need are more receptive to assistance. Case managers accounted for a small percentage of variation in patient engagement.
摘要：
背景：许多患者提供病例管理服务来满足他们的健康和社会需求，选择不参与。推动参与的因素尚不清楚。我们试图了解与参与社会需求病例管理计划相关的患者特征以及病例管理器的可变性。
方法：在2017年8月至2021年2月之间，在康特拉科斯塔县，为43,347名医院或急诊科使用风险较高的医疗补助受益人提供了病例管理，加州2022年使用描述性统计和多水平逻辑回归模型对结果进行了分析，以检查1）患者参与度与患者特征之间的关联以及2）归因于病例管理者的参与度变化。参与被定义为响应案例经理的外联和至少一个要相互解决的主题的文档。通过对COVID-19之前和COVID-19队列进行分层进行敏感性分析。
结果：共有16,811名（39%）合格患者参与。调整后的分析表明，较高的患者参与度与女性性别之间存在关联，40岁及以上，黑人/非裔美国人种族，西班牙裔/拉丁裔，无家可归的历史，以及某些慢性疾病和抑郁症的病史。类内相关系数表明，参与情况变化的6％是在案例管理器级别解释的。
结论：有住房不稳定和特定医疗条件的医疗补助患者更有可能参加病例管理服务，与先前的证据一致，即有更大需求的患者更容易接受援助。病例管理者在患者参与中占很小比例的差异。
方法：在2017年8月至2021年2月之间，在康特拉科斯塔县，为43,347名医院或急诊科使用风险较高的医疗补助受益人提供了病例管理，加州2022年使用描述性统计和多水平逻辑回归模型对结果进行了分析，以检查1）患者参与度与患者特征之间的关联以及2）归因于病例管理者的参与度变化。参与被定义为响应案例经理的外联和至少一个要相互解决的主题的文档。通过对COVID-19之前和COVID-19队列进行分层进行敏感性分析。
结果：共有16,811名（39%）合格患者参与。调整后的分析表明，较高的患者参与度与女性性别之间存在关联，40岁及以上，黑人/非裔美国人种族，西班牙裔/拉丁裔，无家可归的历史，以及某些慢性疾病和抑郁症的病史。类内相关系数表明，参与情况变化的6％是在案例管理器级别解释的。
结论：有住房不稳定和特定医疗条件的医疗补助患者更有可能参加病例管理服务，与先前的证据一致，即有更大需求的患者更容易接受援助。病例管理者在患者参与中占很小比例的差异。
