Care For the Whole Person, For Those Who Need it Most

Guided Care® is a new solution to the growing challenge of caring for older adults with chronic conditions and complex health needs. A Guided Care nurse, based in a primary care office, works with 2-5 physicians and other members of the care team to provide coordinated, patient-centered, cost-effective health care to 50-60 of their chronically ill patients. The Guided Care nurse conducts in-home assessments, facilitates care planning, promotes patient self-management, monitors conditions monthly, coordinates the efforts of all health care professionals, smoothes transitions between sites of care, educates and supports family caregivers, and facilitates access to community resources.

The Roger C Lipitz Center for Integrated Health Care at the Johns Hopkins Bloomberg School of Public Health recently conducted a cluster-randomized controlled trial of Guided Care at 8 community-based primary care practices in the Baltimore-Washington D.C. area that included over 900 patients, 300 caregivers, and 48 primary care physicians. Data indicate that Guided Care improves the quality of patients' care, improves family caregivers' perception of quality, improves physicians' satisfaction with chronic care, produces high job satisfaction among Guided Care Nurses, and may reduce the use of expensive services, especially in integrated care delivery systems. Click here for a summary.

Guided Care won the American Public Health Association's 2008 Archstone Foundation Award for Excellence in Program Innovation. Guided Care also won the 2009 Medical Economics Award for Innovation in Practice Improvement cosponsored by the American Academy of Family Physicians, the Society of Teachers of Family Medicine, and Medical Economics magazine. Guided Care was a finalist for the British Medical Journal's 2010 Getting Research into Practice Award. The Guided Care Program at Kaiser Permanente Mid-Atlantic States won the 2010 Case In Point Platinum Award for Case Management Provider Program. The Guided Care Program at Johns Hopkins HealthCare won Dorland Health's 2011 Silver Crown Award for Case/Care Management Program and Case Management Society of America's 2011 Case Management Research Award.

Organizations are required to obtain a license from Johns Hopkins University in order to use the Guided Care model and to use the service mark "Guided Care" in promotional materials to sell services, to enhance web presence, and for similar purposes.

A Guided Care Chronic Care Management Toolkit is now available that includes the Guided Care license, an implementation manual, 25 booklets for patients and families, one registration in the Guided Care Nursing online course, three registrations in the Practice Leaders in Medical Homes online course, and one hour of telephone consultation.

Copyright, 2005, The Johns Hopkins University. All rights reserved. No distribution or copying of Guided Care materials premitted without express written consent of The Johns Hopkins University. Guided Care® is a registered service mark of The Johns Hopkins University. No use of service mark permitted without express written consent of The Johns Hopkins University.