Care management processes for chronic diseases have held up well during pandemic

The first years of the COVID-19 pandemic saw significant disruption to many aspects of primary care delivery. But one exception, according to a new study, has been in the processes that primary care practices use to manage patients with chronic diseases.

The study’s goal was to determine what role, if any, care management processes (CMPs) played in the worsened outcomes seen among patients with chronic conditions during the early part of the pandemic.

To find out, the authors analyzed data from surveys about the presence and function of CMPs at 269 primary care clinics in Minnesota conducted in 2017, 2019 and 2021. Clinic leaders were asked detailed questions about the presence and functioning of CMPs in six domains important for providing consistent quality care for chronic diseases: information and tracking, chronic disease management, patient self-management, care plans and shared decisions, performance management and managing high-risk patients.

The results revealed that the overall percentage of responding clinics with services in all six domains grew during the survey period, from 72.1% in 2017 to 75.8% in 2021 though there were some differences depending on the size and location of the facility. For example, the number of rural clinics with care plans increased by .5% compared with 6.2% among urban clinics. The number managing high-risk patients increased by 14.4% among clinics belonging to systems with more than 12 sites, but fell by 2.1% among clinics in systems with 12 or fewer sites.

Several domains saw larger increases during the epidemic (2019-2021) than prior to it. For example, the percentage with chronic disease management services rose by 1.4% from 2017 to 2019, then by 2.6% from 2019 to 2021. On the other hand, scores for the performance measurement and managing high-risk patients fell from 2019 to 2021.

The authors note that the improvements in CMPs came despite the fact that close to 90% of the leaders of the participating clinics reported pandemic-related care disruptions ranging from “moderate” to “extreme.”

“The pandemic experience has been very stressful for patient and health care professionals alike, but the health care system in Minnesota appears to be resilient,” they write. “The continued introduction of more highly organized care management may be an important step in recovering from any losses in quality.

The study, “COVID-19 Impacts on Primary Care Clinic Care Management Processes” appears in the January/February 2023 issue of Annals of Family Medicine.