title: 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.
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.
  
  
  METHODS
  Cluster-randomized controlled trial of Guided Care in 14 primary care teams.
  
  
  METHODS
  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).
  
  
  METHODS
  "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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  Guided Care improves self-reported quality of chronic health care for multi-morbid older persons.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. cyboyd@jhmi.edu
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Boyd
authors.forename: Lisa
authors.initials: L
authors.lastname: Reider
authors.forename: Katherine
authors.initials: K
authors.lastname: Frey
authors.forename: Daniel
authors.initials: D
authors.lastname: Scharfstein
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wolff
authors.forename: Carol
authors.initials: C
authors.lastname: Groves
authors.forename: Lya
authors.initials: L
authors.lastname: Karm
authors.forename: Stephen
authors.initials: S
authors.lastname: Wegener
authors.forename: Jill
authors.initials: J
authors.lastname: Marsteller
authors.forename: Chad
authors.initials: C
authors.lastname: Boult
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D010348:Patient Care Team / Q000592:standards* / Q000639:trends; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods / Q000592:standards* / Q000639:trends; D011787:Quality of Health Care / Q000592:standards* / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome