Human factors challenges of patient-related information management for care coordination

In order to coordinate patient care across transitions within and between healthcare organizations, care managers manage patient-related information using multiple health IT applications and paper documents as well as other technologies and tools such as fax and telephone. The aims of this dissertation were: (1) to describe obstacles experienced by care managers to managing patient-related information, and (2) to assess the consequences of these obstacles on care managers and their perceptions of quality of care and patient safety.;We used the work system model and the SEIPS model to guide this research (Carayon, 2009; Carayon et al., 2006; Carayon & Smith, 2000; Smith & Carayon-Sainfort, 1989). This dissertation utilized a cross-sectional survey design to describe obstacles to managing patient-related information, and to analyze the relationship between these obstacles and their consequences on care managers, i.e. workload, burnout and intention to turnover. A web-based questionnaire was used to collect data from 80 out of 131 care managers (61% response rate) located in physician practices, hospitals and a transitions of care call center, and employed by a health plan in central Pennsylvania. Care managers were more likely to consider 'inefficiencies in access to patient-related information' and 'having to use multiple information systems' as major obstacles than 'lack of computer training and support' and 'inefficient use of case management software'. Care managers who were more likely to report inefficient use of case management software an obstacle reported high workload. However, these obstacles did not show a unique contribution to workload when care managers' demographics and characteristics were controlled for in the regression model. Other work system obstacles may contribute to care manager workload. Also, care managers may develop strategies to deal with these obstacles to perform their work efficiently and effectively.;The work system of care managers needs to be redesigned to improve their management of patient-related information. This should improve care managers' performance, and, therefore, quality of care provided to patients. Future research should identify care managers' strategies to deal with these obstacles and perform their job of coordinating patient care.