TY - JOUR
T1 - A matched-pair cluster-randomized trial of guided care for high-risk older patients
AU - Boult, Chad
AU - Leff, Bruce
AU - Boyd, Cynthia M.
AU - Wolff, Jennifer L.
AU - Marsteller, Jill A.
AU - Frick, Kevin D.
AU - Wegener, Stephen
AU - Reider, Lisa
AU - Frey, Katherine
AU - Mroz, Tracy M.
AU - Karm, Lya
AU - Scharfstein, Daniel O.
N1 - Funding Information:
This study was supported by grants from the Agency for Healthcare Research and Quality, the National Institute on Aging, the John A. Hartford Foundation, and the Jacob and Valeria Langeloth Foundation—and by in-kind contributions from Johns Hopkins HealthCare (administrative and information technology support), Johns Hopkins Community Physicians (clinical office space), Kaiser Permanente Mid-Atlantic States (administrative support and clinical office space), MedStar Physician Partners (clinical office space), and the Roger C. Lipitz Center for Integrated Health Care (administrative support).
Funding Information:
Supported by grants from the Agency for Healthcare Research and Quality, the National Institute on Aging, the John A. Hartford Foundation, and the Jacob and Valeria Langeloth Foundation—and by in-kind contributions from Johns Hopkins HealthCare, Johns Hopkins Community Physicians, Kaiser Permanente Mid-Atlantic States, MedStar Physician Partners, and the Roger C. Lipitz Center for Integrated Health Care.
PY - 2013/5
Y1 - 2013/5
N2 - Background: Patients at risk for generating high health care expenditures often receive fragmented, lowquality, inefficient health care. Guided Care is designed to provide proactive, coordinated, comprehensive care for such patients. Objective: We hypothesized that Guided Care, compared to usual care, produces better functional health and quality of care, while reducing the use of expensive health services. Design: 32-month, single-blind, matched-pair, cluster- randomized controlled trial of Guided Care, conducted in eight community-based primary care practices. Patients: The "Hierarchical Condition Category" (HCC) predictive model was used to identify high-risk older patients who were insured by fee-for-service Medicare, a Medicare Advantage plan or Tricare. Patients with HCC scores in the highest quartile (at risk for generating high health care expenditures during the coming year) were eligible to participate. Intervention: A registered nurse collaborated with two to five primary care physicians in providing eight services to participants: comprehensive assessment, evidence-based care planning, proactive monitoring, care coordination, transitional care, coaching for selfmanagement, caregiver support, and access to community- based services. Main Measures: Functional health was measured using the Short Form-36. Quality of care and health services utilization were measured using the Patient Assessment of Chronic Illness Care and health insurance claims, respectively. Key Results: Of the eligible patients, 904 (37.8 %) gave written consent to participate; of these, 477 (52.8 %) completed the final interview, and 848 (93.8 %) provided complete claims data. In intention-to-treat analyses, Guided Care did not significantly improve participants' functional health, but it was associated with significantly higher participant ratings of the quality of care (difference= 0.27, 95 % CI=0.08-0.45) and 29 % lower use of home care (95 % CI=3-48 %). Conclusions: Guided Care improves high-risk older patients' ratings of the quality of their care, and it reduces their use of home care, but it does not appear to improve their functional health.
AB - Background: Patients at risk for generating high health care expenditures often receive fragmented, lowquality, inefficient health care. Guided Care is designed to provide proactive, coordinated, comprehensive care for such patients. Objective: We hypothesized that Guided Care, compared to usual care, produces better functional health and quality of care, while reducing the use of expensive health services. Design: 32-month, single-blind, matched-pair, cluster- randomized controlled trial of Guided Care, conducted in eight community-based primary care practices. Patients: The "Hierarchical Condition Category" (HCC) predictive model was used to identify high-risk older patients who were insured by fee-for-service Medicare, a Medicare Advantage plan or Tricare. Patients with HCC scores in the highest quartile (at risk for generating high health care expenditures during the coming year) were eligible to participate. Intervention: A registered nurse collaborated with two to five primary care physicians in providing eight services to participants: comprehensive assessment, evidence-based care planning, proactive monitoring, care coordination, transitional care, coaching for selfmanagement, caregiver support, and access to community- based services. Main Measures: Functional health was measured using the Short Form-36. Quality of care and health services utilization were measured using the Patient Assessment of Chronic Illness Care and health insurance claims, respectively. Key Results: Of the eligible patients, 904 (37.8 %) gave written consent to participate; of these, 477 (52.8 %) completed the final interview, and 848 (93.8 %) provided complete claims data. In intention-to-treat analyses, Guided Care did not significantly improve participants' functional health, but it was associated with significantly higher participant ratings of the quality of care (difference= 0.27, 95 % CI=0.08-0.45) and 29 % lower use of home care (95 % CI=3-48 %). Conclusions: Guided Care improves high-risk older patients' ratings of the quality of their care, and it reduces their use of home care, but it does not appear to improve their functional health.
KW - Care management
KW - Multi-morbidity
KW - Primary care
KW - Randomized controlled trial
KW - Transitional care
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U2 - 10.1007/s11606-012-2287-y
DO - 10.1007/s11606-012-2287-y
M3 - Article
C2 - 23307395
AN - SCOPUS:84891419082
VL - 28
SP - 612
EP - 621
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 5
ER -