Levering the Trusted Clinician: Increasing Retention in Disease Management through Integrated Program Delivery
Published: Population Health Management 2008; 11(5):247-254
Authors: Sharon Glave Frazee PhD, Bruce Sherman MD, Raymond Fabius MD, Pamela Ryan RN BSN MHA CPHQ CCM, Patricia Kirkpatrick RN, Jeffery Davis MBA
Objective:
The objective of this study is to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending), which combines telephonic-delivered disease management (TDM) with a worksite-based primary care center and pharmacy delivery, yields higher patient retention rates than traditional remote DM alone. An earlier study of the IDM protocol found that integrating a worksite-based primary care and pharmacy delivery system with traditional telephonic-based DM substantially increased contact, enrollment, and engagement rates compared to traditional stand-alone telephonic DM. Methods: This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols and compares participation rates at 6- and 12-month intervals as well as measures of continued retention in the DM program. Results: The IDM protocol showed a significant improvement in participation persistence over traditional TDM. Conclusion: Diseasse management’s (DM’s) value largely depends on achieving and maintaining participation. Simply being enrolled in a program does not guarantee engaged participation by enrollees, a necessary factor to achieve the improved health outcomes and subsequent reduced health care costs that are the ultimate objective of DM. Integrating a worksite-based primary care and pharmacy delivery system led by “trusted clinicians at the workplace”™ with traditional telephonic-based DM not only increases contact and enrollment rates, but also results in higher patient engagement and retention. These improvements in participation are expected to result in improved outcomes for a larger proportion of the target population than traditional telephonic DM.
Commentary:
The promise of population health management programs resides chiefly in its ability to engage worthy participants in a sustained way to allow for its positive impacts. Most efforts in disease management require patients to change behavior – either by converting to a healthier lifestyle or by being more compliant with evidence-based therapeutic guidelines. Without engagement and retention within programs this is not possible. Integrating population management programs with trusted clinicians particularly at the workplace or within community practices of high esteem is a key method to accomplish this. Leveraging the bond established between patients and their trusted clinician to create engagement, retention and ultimately behavioral improvements is a powerful and under-utilized effort in medical management.