July 20, 2010 Physicians who provided Guided Care, a primary care enhancement program for patients with multiple chronic conditions, reported higher levels of satisfaction with their patient/family communications and their knowledge of their patients' clinical characteristics, according to a study by researchers at the Johns Hopkins Bloomberg School of Public Health.
The research, published in the July/August edition of Annals of Family Medicine, found that after one year of a multi-site randomized controlled trial, Guided Care physicians were significantly more satisfied with patient/family communications than physicians who provide usual care. Guided Care physicians were also significantly more satisfied with their knowledge of their patients' clinical characteristics.
"These findings suggest that Guided Care provides significant benefits to physicians by improving communications with chronically ill older patients and their families," said Jill Marsteller, PhD, MPP, the lead author of the study and assistant professor at the Bloomberg School's Department of Health Policy and Management. "Physician satisfaction is another important element of improving chronic care, in addition to improving the quality of care and reducing costs. The quality of patient-physician communications affects patients' knowledge of their illness, adherence to treatment recommendations and ultimately, their health outcomes."
Previously published data suggest that compared to patients who receive "usual care," Guided Care patients tend to spend less time in hospitals and skilled nursing facilities and have fewer emergency room visits and home health episodes, producing an annual net savings for health 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 improves patients' ratings of the quality of their care and reduces family caregiver strain.
Guided Care is a model of comprehensive health care provided by physician-nurse teams for people with several chronic health conditions. It is a type of "medical home" for the growing number of older adults with multiple chronic conditions. The model is designed to improve the quality of life and the quality of health care, while improving the efficiency of treating the sickest and most complex patients. Guided Care teams include a registered nurse, two to five physicians, and other members of the office staff, all of whom work together for the benefit of each patient. In partnership with the primary care physician, the Guided Care nurse conducts in-home comprehensive assessments, facilitates care planning, educates and empowers patients and families, monitors their conditions monthly, and coordinates the efforts of health care professionals, hospitals, and community agencies to ensure that no important health-related need slips through the cracks.
A multi-site, randomized controlled trial of Guided Care involving 49 physicians, 904 older patients and 319 family members recently concluded in eight locations in the Baltimore-Washington, D.C. area. The three-year study was funded by a public-private partnership of the John A. Hartford Foundation, the Agency for Healthcare Research and Quality, the National Institute on Aging, and the Jacob and Valeria Langeloth Foundation.
Additional authors of "Physician Satisfaction with Chronic Care Processes: A Cluster-Randomized Trial of Guided Care" include: Yea-Jen Hsu, MHA; Lisa Reider, MHS; Katherine Frey, MPH; Jennifer Wolff, PhD; Cynthia M. Boyd, MD, MPH; Bruce Leff, MD; Daniel Scharfstein, ScD; and Chad Boult, MD, MPH, MBA, from Johns Hopkins University, and Lya Karm, MD, from Kaiser Permanente Mid-Atlantic States. This work, which is a part of the larger study, was funded by the John A. Hartford Foundation and the Roger C. Lipitz Center for Integrated Health Care.
About Guided Care
The award-winning Guided Care model was developed by a team of clinical researchers at Johns Hopkins University 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, comprised of national leaders in medicine, nursing, health policy, patient advocacy and health insurance. Guided Care has won several awards, including the American Public Health Association's 2008 Archstone Foundation Award for Excellence in Program Innovation, the 2009 Medical Economics Award for Innovation in Practice Improvement, and the 2010 Case In Point Platinum Award for Case Management Provider Program. For more information, please visit: www.GuidedCare.org. For information on tools for adopting Guided Care, please visit: www.MedHomeInfo.org.
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The above story is based on materials provided by Johns Hopkins University Bloomberg School of Public Health.
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- Jill A. Marsteller, Yea-Jen Hsu, Lisa Reider, Katherine Frey, Jennifer Wolff, Cynthia Boyd, Bruce Leff, Lya Karm, Daniel Scharfstein, and Chad Boult. Physician Satisfaction with Chronic Care Processes: A Cluster-Randomized Trial of Guided Care. Annals of Family Medicine, 2010; 8: 308-315 [link]
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