February 1, 2010

Guided Care participants rate quality of health care higher

Chronically ill older adults who are closely supported by a nurse-physician primary care team are twice as likely to rate their health care as high-quality than those who receive usual care, according to a study by researchers at the Johns Hopkins Bloomberg School of Public Health.

The research, published online in the latest edition of the Journal of General Internal Medicine, found that after 18 months of a randomized controlled trial, Guided Care recipients rated their primary care significantly higher than did recipients of usual care with regard to coordination with specialists, support for self-management and help received with setting goals, making decisions and solving health-related problems. Guided Care patients were also 70 percent more likely to rate the time they had to wait for an appointment when sick as “excellent” or “good” and 50 percent more likely to rate the ability to get phone advice as “excellent” or “good.”

Guided Care is a model of proactive, comprehensive health care provided by physician-nurse teams for patients with several chronic health conditions. It is a type of “medical home” for this rapidly growing population. This model is designed to improve complex patients’ quality of life and quality of care while improving the efficiency of their treatment. The care teams include a registered nurse, two to five primary care physicians and other members of the office staff who work together for the benefit of each patient. Following a comprehensive assessment and planning process, the Guided Care nurse educates and empowers patients and families, monitors the patients’ conditions monthly and coordinates the efforts of health care professionals, hospitals and community agencies to be sure that no important health-related need slips through the cracks.

“These findings show that Guided Care can improve many of the important dimensions of care quality,” said Cynthia M. Boyd of Johns Hopkins, lead author of the study and an assistant professor in the Department of Medicine at the School of Medicine and in the Department of Health Policy and Management at the Bloomberg School. “Improving chronic care is not just about reducing cost, but it also includes improving the quality of the care that patients receive.”

Previously published data suggested that, compared to usual-care patients, Guided Care patients tended to spend less time in hospitals and skilled nursing facilities and had fewer emergency room visits and home health episodes, producing an annual net savings for health care insurers (after accounting for the costs of Guided Care) of $1,365 (11 percent) per patient, or $75,000 per nurse. Other studies have shown that Guided Care reduces family caregiver strain and improves physicians’ satisfaction with chronic care.

A multisite randomized controlled trial of Guided Care involving 49 physicians, 904 older patients and 308 family members recently concluded in eight locations in the Baltimore-Washington, D.C., area. The three-year study was supported by a public-private partnership of the Agency for Healthcare Research and Quality, the National Institute on Aging, the John A. Hartford Foundation, the Jacob and Valeria Langeloth Foundation, Kaiser Permanente Mid-Atlantic States, Johns Hopkins HealthCare and the Roger C. Lipitz Center for Integrated Health Care.

Additional authors of the study are Lisa Reider, Katherine Frey, Daniel Scharfstein, Bruce Leff, Jennifer Wolff, Stephen Wegener, Jill Marsteller and Chad Boult, all of Johns Hopkins; and Carol Groves and Lya Karm, both of Kaiser Permanente Mid-Atlantic States.

The Guided Care model was developed by a team of clinical researchers at Johns Hopkins beginning in 2001 with funding from the Agency for Healthcare Research and Quality, the National Institute on Aging, the John A. Hartford Foundation and the Jacob and Valeria Langeloth Foundation. The team is supported by a Stakeholder Advisory Committee, comprising national leaders in medicine, nursing, psychology, public health, health policy, patient advocacy and health insurance. For more information, go to www.GuidedCare.org.