Understanding Perspectives on Care Manager Competencies: A Multiple-Method Needs Assessment

Abstract

Background: Home-based primary care may be well situated as an alternative to conventional episodic primary care for chronically ill older adults, potentially delaying and reducing long-term care admissions while improving satisfaction with care and quality of life. Care management, which seeks to assist patients and their support systems in managing their illnesses, could play a key role in providing home-based primary care. However, little is known about the attributes and competencies a care manager should have when working in home-based primary care.

Objectives: To identify necessary competencies for care managers who work with older adults, verify competencies in a home-based setting, and gain a deeper understanding of why the competencies are important. Methods: A scoping review following Arksey and O’Malley’s framework was conducted. A search string encompassing care integration, care management, and clinical competence was used to find academic literature on PubMed, CINAHL, and Scopus. The academic search string was adapted to custom Google searches and targeted website searches to identify grey literature. Extracted competencies were organized into similar groups. The sixth step of Arksey and O’Malley’s framework, consultation, was conducted using a quantitative survey to verify the literature review’s findings, and qualitative interviews to gain a greater understanding. The survey used the competencies uncovered in the scoping review and asked care managers and healthcare providers to rank the importance of competency groups with respect to one another, and rate the importance of individual competencies from -3 to +3, with -3 being very unimportant and +3 being very important, in a home-based setting.

Results: The literature review identified 125 competencies from 65 academic articles and pieces of grey literature. These were categorized into 13 groups in three audience-facing facets. A total of 20 survey participants rated competencies and ranked competency groups, the averages of which were used to ascertain the degree to which they are important for care managers. The highest-rated competencies were patient-facing relationship and rapport building (2.90) and patient-facing confidentiality (2.90); the highest-ranked competency group was patient care management (2.80). Cronbach’s alpha for the survey was 0.93. A follow-up interview was conducted which provided further endorsement and nuance for some competencies, as well as a test for the feasibility of further qualitative investigation.

Discussion and Conclusion: The findings provide support for the importance of competencies for care managers who work in home-based settings with older adults. The review identified competencies beyond those suggested by professional organizations; these included personality traits and caregiver support and communication. Further contextualization is needed to gain a deeper understanding of why the identified competencies are important. Practitioners should be aware of the breadth of competencies a care manager may need to possess when working in home-based settings with older adults and should prioritize training according to their importance.