Early effects of "Guided Care" on the quality of health care for multimorbid older persons: a cluster-randomized controlled trial.
BACKGROUND
The quality of health care for older Americans with multiple chronic conditions is suboptimal. We designed "Guided Care" (GC) to enhance quality of care by integrating a registered nurse, intensively trained in chronic care, into primary care practices to work with physicians in providing comprehensive chronic care to 50-60 multimorbid older patients.


METHODS
We hypothesized that GC would improve the quality of health care for this population. In 2006, we began a cluster-randomized controlled trial of GC at eight practices (n = 49 physicians). Older patients of these practices were eligible to participate if they were at risk for using health services heavily during the coming year. Teams of two to five physicians and their at-risk older patients were randomized to either GC or usual care (UC). Six months after baseline, participants rated the quality of their health care by answering validated closed-ended questions from telephone interviewers who were masked to group assignment.


RESULTS
Of the 13,534 older patients screened, 2391 (17.7%) were eligible to participate in the study, of which 904 (37.8%) gave informed consent and were cluster-randomized. After 6 months, 93.8% and 93.2% of the GC and UC participants who remained alive and eligible completed telephone interviews. GC participants were more likely than UC participants to rate their care highly (adjusted odds ratio = 2.0, 95% confidence interval, 1.2-3.4, p =.006), and primary care physicians were more likely to be satisfied with their interactions with chronically ill older patients and their families (p <.05).


CONCLUSIONS
GC improves important aspects of the quality of health care for multimorbid older persons. Additional data will become available as this trial continues.
Boult
Chad
C
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. cboult@jhsph.edu
Reider
Lisa
L
Frey
Katherine
K
Leff
Bruce
B
Boyd
Cynthia M
CM
Wolff
Jennifer L
JL
Wegener
Stephen
S
Marsteller
Jill
J
Karm
Lya
L
Scharfstein
Daniel
D
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D008297:Male; D009740:Nursing Staff; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010821:Physicians, Family; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D011787:Quality of Health Care / Q000592:standards*; D011795:Surveys and Questionnaires; D013997:Time Factors