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

Alwyn Cassil (202) 264-3484 or

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 Conditionsavailable 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:

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.