The Core of Care Management: The Role of Authentic Relationships in Caring for Patients with Frequent Hospitalizations

Abstract

In the movement to improve the health of patients with multiple chronic conditions and vulnerabilities, while reducing the need for hospitalizations, care management programs have garnered wide attention and support. The qualitative data presented in this paper sheds new light on key components of successful chronic care management programs. By going beyond a task- and temporal-based framework, this analysis identifies and defines the importance of “authentic healing relationships” in driving individual and systemic change. Drawing on the voices of 30 former clients of the Camden Coalition of Healthcare Providers, the investigators use qualitative methods to identify and elaborate the core elements of the authentic healing relationship—security, genuineness, and continuity—a relationship that is linked to patient motivation and active health management. Although not readily found in the traditional health care delivery system, these authentic healing relationships present significant implications for addressing the persistent health-related needs of patients with frequent hospitalizations. (Population Health Management 2016;19:248–256)

Frequent emergency department visitors are frequent primary care visitors and report unmet primary care needs

“…These surveys would benefit from detailed questions on patients' perceived met and unmet primary care needs and whether ED visits are meeting their unmet primary care needs. Additional qualitative research can build on Camden Coalition findings regarding frequent healthcare users' perceptions of their PCP relationships and how these individuals characterize successful authentic healing relationships with their health care providers. Semistructured interviews or focus groups with frequent ED visitors could also illuminate the psychosocial and medical characteristics that influence their ED use.…”

“…They described trusting, continuous relationships with their health care team as important . Another qualitative study of Camden Coalition participants found that they valued an authentic healing relationship characterized by sincerity and genuineness …”

“…25 Another qualitative study of Camden Coalition participants found that they valued an authentic healing relationship characterized by sincerity and genuineness. 26 Given the continued prevalence of frequent ED use, additional research is clearly needed to understand frequent ED visitors' relationships with their PCPs. The purpose of this study is to describe frequent ED visitors' primary care utilization and perceptions of primary care access, continuity, and connectedness; to compare the primary care perceptions of frequent and infrequent ED visitors; and to examine primary care use and perceptions as predictors of ED use.…”

Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study

“…A qualitative study by Grinberg et al 41 on the key components of successful case management reported that the development of a healing relationship between clinicians and their patients was based on security, genuineness, and continuity of care. A nonrandomized but controlled study by Adam et al 42 demonstrated an improvement in patient well-being after the implementation of a case management intervention by an interdisciplinary care team.…”

“…The qualitative study by Grinberg et al 41 similarly suggested that the healing relationship between clinicians and their patients, based on security, could motivate the patient to engage in self-management. Another study, by Chapman et al, 44 with 31 health care professionals demonstrated that case management met patient needs through patient education about selfmanagement of their conditions.…”