• J Gen Intern Med · Mar 2010

    Randomized Controlled Trial Multicenter Study Comparative Study

    The effects of guided care on the perceived quality of health care for multi-morbid older persons: 18-month outcomes from a cluster-randomized controlled trial.

    • Cynthia M Boyd, Lisa Reider, Katherine Frey, Daniel Scharfstein, Bruce Leff, Jennifer Wolff, Carol Groves, Lya Karm, Stephen Wegener, Jill Marsteller, and Chad Boult.
    • Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. cyboyd@jhmi.edu
    • J Gen Intern Med. 2010 Mar 1; 25 (3): 235242235-42.

    BackgroundThe quality of health care for older Americans with chronic conditions is suboptimal.ObjectiveTo evaluate the effects of "Guided Care" on patient-reported quality of chronic illness care.DesignCluster-randomized controlled trial of Guided Care in 14 primary care teams.ParticipantsOlder patients of these teams were eligible to participate if, based on analysis of their recent insurance claims, they were at risk for incurring high health-care costs during the coming year. Small teams of physicians and their at-risk older patients were randomized to receive either Guided Care (GC) or usual care (UC).Intervention"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 multi-morbid older patients.MeasurementsEighteen 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 patient-reported quality of chronic illness care.ResultsOf the 13,534 older patients screened, 2,391 (17.7%) were eligible to participate in the study, of which 904 (37.8%) gave informed consent and were cluster-randomized. After 18 months, 95.3% and 92.2% 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 = 2.13, 95% CI = 1.30-3.50, p = 0.003).ConclusionGuided Care improves self-reported quality of chronic health care for multi-morbid older persons.

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