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
Open accessAbstract
Background The quality of health care for older Americans with chronic conditions is suboptimal.Objective To evaluate the effects of "Guided Care" on patient-reported quality of chronic illness care.Design Cluster-randomized controlled trial of Guided Care in 14 primary care teams.Participants 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 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.Measurements Eighteen 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.Results Of 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).Conclusion Guided Care improves self-reported quality of chronic health care for multi-morbid older persons.
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Chronically ill patients at higher risk of emergency room use, hospitalization, or major complications benefit from more intensive follow-up and clinical management by a care manager.
“Chronically ill patients at higher risk of emergency room use, hospitalization, or major complications have been shown to benefit from more intensive follow-up and clinical management by a care manager.”
From Self-management: Enabling and empowering patients living with cancer as a chronic illness (2011) · cites this paper as [44]
Clinical care management includes clinical assessment, medication management, self-management support, and care coordination, including among post-surgical cancer patients.
“Clinical care management, generally provided by a health care professional such as a nurse or clinical pharmacist, includes clinical assessment, medication management, self-management support, and care coordination28,39-44, including among post-surgical cancer patients14,15,45.”
From Self-management: Enabling and empowering patients living with cancer as a chronic illness (2011) · cites this paper as [44]
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- Authors
- Boyd, C. M., Reider, L., Frey, K., Scharfstein, D., Leff, B., Wolff, J., Groves, C., Karm, L., Wegener, S., Marsteller, J., & Boult, C.
- Affiliations
- Johns Hopkins University (US)
- Kaiser Permanente (US)
- Corresponding author
- Boyd, Cynthia M.
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2009-12-22
- Volume
- 25
- Issue
- 3
- Pages
- 235-242
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2839336
- OpenAlex
- W2011882915
- Cited by
- 159
- References
- 26
- Citations by year
- 2026: 2 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 7 · 2020: 4 · 2019: 4 · 2018: 12 · 2017: 19 · 2016: 19 · 2015: 15 · 2014: 8 · 2013: 16 · 2012: 15
- FWCI
- 8.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- John A. Hartford Foundation
- Battelle
- Hartford Foundation for Public Giving
- Kaiser Permanente
- University of Minnesota
- Johns Hopkins University
- Jacob and Valeria Langeloth Foundation
- Agency for Healthcare Research and Quality
- National Institute on Aging (K23AG032910)
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- patient-reported quality of care, multimorbidity, older adults, chronic care, primary health care teams, nurse-led care, chronic care management, Patient Assessment of Chronic Illness Care
- MeSH terms
- Aged, Aged, 80 and over, Female, Humans, Male, Morbidity, Patient Care Team, Primary Health Care, Quality of Health Care, Time Factors, Cluster Analysis, Treatment Outcome, Patient Satisfaction
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