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Click here to hear what doctors say about Guided Care. |
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Study Results
The Lipitz Center conducted a 1-year pilot test of Guided Care in a primary care practice in urban Baltimore during 2003-2004. The patients who received Guided Care rated their quality of care significantly higher than patients who received “usual care.” [Boyd CM et al. JGIM 2008.] In addition, the average insurance costs for Guided Care patients were 25% lower over a six month period. [Sylvia ML et al. Dis Manag 2008.]
Encouraged by these results, the Lipitz Center secured funding from the John A. Hartford Foundation, the Agency for Healthcare Research and Quality, the National Institute on Aging, and the Jacob and Valeria Langeloth Foundation to conduct at 32-month cluster-randomized controlled trial of Guided Care in 8 community-based primary care practices in the Baltimore-Washington, DC region to evaluate the effects of Guided Care on the quality, efficiency and clinical outcomes of health care for chronically ill older patients and their informal caregivers. The trial began in 2006 and ended in June 2009; 904 patients and 308 family caregivers participated. Analyses of the 32-month data are underway.
Data from the trial indicate that Guided Care:
- Improves the quality of patients' care. After 18 months, Guided Care patients were more than twice as likely as usual care patients to rate the quality of their care highly. [Boyd CM et al. 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. J Gen Intern Med 2010;25(3):235-42.]
- Improves family caregivers' perception of quality. After 18 months, caregivers of Guided Care patients reported the quality of chronic illness care received by their loved one to be significantly higher than usual care caregivers. Those employed in addition to their caregiving role also reported increased work productivity, low absenteeism, and a decline in presenteeism. [Wolff JL et al. Effects of Guided Care on Family Caregivers. Gerontologist 2010;50(4):459-70.]
- Improves physicians' satisfaction with chronic care. Compared to physicians in the control group, physicians who provided Guided Care for 1 year reported higher levels of satisfaction with their patient/family communications and their knowledge of their patients' clinical characteristics. [Marsteller J et al. Physician Satisfaction with Chronic Care Processes: a Cluster-Randomized Trial of Guided Care. Ann Fam Med 2010;8(4):308-15.]
- Produces high job satisfaction among Guided Care Nurses. Guided Care nurses reported a high regard for most aspects of their jobs, consistently expressing high satisfaction with work hour flexibility and the model of care they provide. [Boult C et al. Early Effects of Guided Care on the Quality of Health Care for Multimorbid Older Persons: A Cluster-Randomized Trial. J Gerontol Med Sci 2008;63A(3):321-7.]
- May reduce the use of expensive services, especially in integrated health care delivery systems. After 20 months, Guided Care patients experienced, on average, 30% fewer home health care episodes, 21% fewer hospital readmissions, 16% fewer skilled nursing facility days, and 8% fewer skilled nursing facility admissions; only the reduction in home health care episodes was statistically significant. Guided Care produced even larger reductions in a subset of patients who received their primary care from an integrated delivery system. Guided Care patients in Kaiser Permanente of the Mid Atlantic States experienced, on average, 52% fewer skilled nursing facility days, 47% fewer skilled nursing facility admissions, 49% fewer hospital readmissions, and 17% fewer emergency department visits; the differences for skilled nursing facility days and admissions were statistically significant. [Boult C et al. The Effect of Guided Care Teams on the Use of Health Services: Results from a Cluster-Randomized Controlled Trial. Arch Intern Med 2011;171(5):460-6.]
For more details, click on these links to view abstracts, presentations and publications.
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