Original Article

Journal of General Internal Medicine

, Volume 25, Issue 3, pp 235-242

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. BoydAffiliated withJohns Hopkins Bloomberg School of Public HealthJohns Hopkins University School of MedicineCenter on Aging and Health Email author 
  • , Lisa ReiderAffiliated withJohns Hopkins Bloomberg School of Public Health
  • , Katherine FreyAffiliated withJohns Hopkins Bloomberg School of Public Health
  • , Daniel ScharfsteinAffiliated withJohns Hopkins Bloomberg School of Public HealthJohns Hopkins University School of Medicine
  • , Bruce LeffAffiliated withJohns Hopkins Bloomberg School of Public HealthJohns Hopkins University School of Medicine
  • , Jennifer WolffAffiliated withJohns Hopkins Bloomberg School of Public HealthJohns Hopkins University School of Medicine
  • , Carol GrovesAffiliated withKaiser-Permanente Mid-Atlantic States
  • , Lya KarmAffiliated withKaiser-Permanente Mid-Atlantic States
  • , Stephen WegenerAffiliated withJohns Hopkins Bloomberg School of Public HealthJohns Hopkins University School of Medicine
    • , Jill MarstellerAffiliated withJohns Hopkins Bloomberg School of Public Health
    • , Chad BoultAffiliated withJohns Hopkins Bloomberg School of Public HealthJohns Hopkins University School of Medicine

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Abstract

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.

KEY WORDS

quality of care chronic illness older