Clinical nurse specialist care managers’ time commitments in a disease‐management program for bipolar disorder

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.