The Effects of Guided Care on the Perceived Qualit

Authors: Cynthia M Boyd Lisa Reider Katherine Frey Daniel Scharfstein Bruce Leff Jennifer Wolff Carol Groves Lya Karm Stephen Wegener Jill Marsteller Chad Boult

Publish Date: 2009/12/22

Volume: 25, Issue: 3, Pages: 235-242

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Abstract

Older patients of these teams were eligible to participate if based on analysis of their recent insurance claims they were at risk for incurring high healthcare costs during the coming year Small teams of physicians and their atrisk older patients were randomized to receive either Guided Care GC or usual care UC“Guided Care” is designed to enhance the quality of health care by integrating a registered nurse trained in chronic care into a primary care practice to work with 2–5 physicians in providing comprehensive chronic care to 50–60 multimorbid older patientsEighteen months after baseline interviewers blinded to group assignment administered the Patient Assessment of Chronic Illness Care PACIC survey by telephone Logistic and linear regression was used to evaluate the effect of the intervention on patientreported quality of chronic illness careOf the 13534 older patients screened 2391 177 were eligible to participate in the study of which 904 378 gave informed consent and were clusterrandomized After 18 months 953 and 922 of the GC and UC recipients who remained alive and eligible completed interviews Compared to UC recipients GC recipients had twice greater odds of rating their chronic care highly aOR = 213 95 CI = 130–350 p = 0003Supported by the John A Hartford Foundation the Agency for Healthcare Research and Quality the National Institute on Aging the Jacob and Valeria Langeloth Foundation KaiserPermanente MidAtlantic States Johns Hopkins HealthCare and the Roger C Lipitz Center for Integrated Health CareThe authors acknowledge the invaluable contributions to this study made by Johns Hopkins Community Physicians MedStar Physician Partners Battelle Centers for Public Health Research the Centers for Medicare Medicaid Services Accumen ResDAC the University of Minnesota Survey Research Center the study consultants Jean Giddens RN PhD Kate Lorig RN DrPH Richard Bohmer MD MPH MBA and Mary Naylor RN PhD the nurse managers Lora Rosenthal RN and Carol Groves RN MPA data analysts Martha Sylvia RN MSN MBA and Paula Norman BS administrative assistant Adriane King MA and all of the participating patients caregivers physicians and Guided Care nursesDr Boyd received an honorarium for speaking on multimorbidity at a conference jointly sponsored by AHRQ Center for HealthCare Strategies and Schaller Anderson in 2006 Ms Frey received an honorarium for speaking at a conference in Spain on multidisciplinary heart failure programs sponsored by the Grupo Menarini Dr Marsteller has stock and stock options in Freddie Mac husband’s employer Dr Karm is employed by the MidAtlantic Permanente Group for profit which is the exclusive partner of Kaiser Permanente not for profit Ms Groves is employed by the notforprofit Kaiser Health Plan which has an exclusive contract with the MidAtlantic Permanente Group

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