Guided care: Cost and utilization outcomes in a pilot study

Martha Sylvia, Michael Griswold, Linda Dunbar, Cynthia Boyd, Margaret Park, Chad Boult

Research output: Contribution to journalArticle

Abstract

Guided Care (GC) is an enhancement to primary care that incorporates the operative principles of disease management and chronic care innovations. In a 6-month quasi-experimental study, we compared the cost and utilization patterns of patients assigned to GC and Usual Care (UC). The setting was a community-based general internal medicine practice. The participants were patients of 4 general internists. They were older, chronically ill, community-dwelling patients, members of a capitated health plan, and identified as high risk. Using the Adjusted Clinical Groups Predictive Model® (ACG-PM), we identified those at highest risk of future health care utilization. We selected the 75 highest-risk older patients of 2 internists at a primary care practice to receive GC and the 75 highest-risk older patients of 2 other internists in the same practice to receive UC. Insurance data were used to describe the groups' demographics, chronic conditions, insurance expenditures, and utilization. Among our results, at baseline, the GC (all targeted patients) and UC groups were similar in demographics and prevalence of chronic conditions, but the GC group had a higher mean ACG-PM risk score (0.34 vs. 0.20, p <0.0001). During the following 6 months, the GC group had lower unadjusted mean insurance expenditures, hospital admissions, hospital days, and emergency department visits (p > 0.05). There were larger differences in insurance expenditures between the GC and UC groups at lower risk levels (at ACG-PM = 0.10, mean difference = $4340; at ACG-PM = 0.6, mean difference = $1304). Thirty-one of the 75 patients assigned to receive GC actually enrolled in the intervention. These results suggest that GC may reduce insurance expenditures for high-risk older adults. If these results are confirmed in larger, randomized studies, GC may help to increase the efficiency of health care for the aging American population.

Original languageEnglish (US)
Pages (from-to)29-36
Number of pages8
JournalDisease Management
Volume11
Issue number1
DOIs
StatePublished - Feb 1 2008

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Costs and Cost Analysis
Insurance
Health Expenditures
Primary Health Care
Patient Acceptance of Health Care
Demography
Independent Living
Internal Medicine
Disease Management
Patient Care
Chronic Disease
Delivery of Health Care
Health
Population

ASJC Scopus subject areas

  • Health Policy

Cite this

Sylvia, M., Griswold, M., Dunbar, L., Boyd, C., Park, M., & Boult, C. (2008). Guided care: Cost and utilization outcomes in a pilot study. Disease Management, 11(1), 29-36. https://doi.org/10.1089/dis.2008.111723

Guided care : Cost and utilization outcomes in a pilot study. / Sylvia, Martha; Griswold, Michael; Dunbar, Linda; Boyd, Cynthia; Park, Margaret; Boult, Chad.

In: Disease Management, Vol. 11, No. 1, 01.02.2008, p. 29-36.

Research output: Contribution to journalArticle

Sylvia, M, Griswold, M, Dunbar, L, Boyd, C, Park, M & Boult, C 2008, 'Guided care: Cost and utilization outcomes in a pilot study', Disease Management, vol. 11, no. 1, pp. 29-36. https://doi.org/10.1089/dis.2008.111723
Sylvia, Martha ; Griswold, Michael ; Dunbar, Linda ; Boyd, Cynthia ; Park, Margaret ; Boult, Chad. / Guided care : Cost and utilization outcomes in a pilot study. In: Disease Management. 2008 ; Vol. 11, No. 1. pp. 29-36.
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