Clinical nurse specialist care managers' time commitments in a disease-management program for bipolar disorder.

Abstract:

OBJECTIVES:As part of a cost-effectiveness analysis for Department of Veterans Affairs Cooperative Studies Program #430, 'Reducing the Efficacy-Effectiveness Gap in Bipolar Disorder,' we conducted a time and motion study to quantify the time psychiatric clinical nurse specialist (CNS) care managers spent providing care for patients. METHODS:Clinical nurse specialist care managers completed activity logs in which they recorded time spent implementing the Bipolar Disorders Program (BDP) during a 1-week period in spring, summer, fall and winter over a 1-year period when caseloads were at steady state. Mean service time was estimated by use of univariate analysis of means and by multivariable regression analysis. RESULTS:On average CNS care managers spent 40% of their clinical time in activities that typically are reimbursed (e.g. clinic visits) and spent the remaining 60% of their time in activities that are typically unreimbursed. Total clinic time increased as the number of visits per day increased; however, this increase got smaller with each additional visit per day. CONCLUSIONS:As with other chronic illness management programs, CNS care managers expend a substantial portion of their clinical effort for the BDP in activities that are typically unreimbursed. Their activities have a fixed component per day as well as a component that systematically varies with the number of visits per day. These findings should be considered when costing out and disseminating psychiatric and other medical chronic illness management programs.

journal_name

Bipolar Disord

journal_title

Bipolar disorders

authors

Glick HA,Kinosian B,McBride L,Williford WO,Bauer MS,CSP #430 Study Team.

doi

10.1111/j.1399-5618.2004.00159.x

keywords:

subject

Has Abstract

pub_date

2004-12-01 00:00:00

pages

452-9

issue

6

eissn

1398-5647

issn

1399-5618

pii

BDI159

journal_volume

6

pub_type

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