The purpose of this proposed research is to improve clinical care by enhancing collaborative care models through collaborative care agents and computer-supported guidelines. Specifically, we study the contribution of care managers - clinical professionals directly involved with creating patient specific care plans and communicating with other providers - as collaborative care agents in the implementation of information system initiatives such as computer-supported guidelines. Care managers are uniquely suited to aid in such initiatives, since they use participative, collaborative decision-making to create patient-specific care plans. Thus, they address a key failure of computer-supported guidelines: the inability to make patient specific, flexible plans from often inflexible guideline efforts. The research will consist of several stages: information need assessment and concept mapping; guideline creation by and adjustment for care managers; and evaluation of implemented guidelines. Using qualitative and quantitative methods, a controlled trial will be performed to assess the key aspects of care manager involvement in assuring implementation success. Outcomes considered will be satisfaction, perceived benefits, patient adherence and projected morbidity, and projected cost-effectiveness of care managers within a large health system. A quality improvement framework will be constructed from the key perceived benefits of care management to further aid in development and implementation of computer-supported guidelines. This proposed research will further our understanding not only of collaborative care models and information systems initiative, but also improve our understanding of the crucial role of collaborative care agents - dedicated people who help achieve the benefits of both collaborative care models and computer-supported guidelines.
