Physician satisfaction with chronic care processes: a cluster-randomized trial of guided care.
OBJECTIVE
Chronically ill older patients with multiple conditions are challenging to care for, and new models of care for this population are needed. This study evaluates the effect of the Guided Care model on primary care physicians' impressions of processes of care for chronically ill older patients.


METHODS
In Guided Care a specially educated registered nurse works at the practice with 2 to 5 primary care physicians, performing 8 clinical activities for 50 to 60 chronically ill older patients. The care model was tested in a cluster-randomized controlled trial between 2006 and 2009. All eligible primary care physicians in 14 pods (teams of physicians and their chronically ill older patients) agreed to participate (n = 49). Pods were randomly assigned to provide either Guided Care or usual care. Physicians were surveyed at baseline and 1 year later. We assessed the effects of Guided Care using responses from 38 physicians who completed both survey questionnaires. We measured physicians' satisfaction with chronic care processes, time spent on chronic care, knowledge of their chronically ill older patients, and care coordination provided by physicians and office staff.


RESULTS
Compared with the physicians in the control group, those in the Guided Care group rated their satisfaction with patient/family communication and their knowledge of the clinical characteristics of their chronically ill older patients significantly higher (rho<0.05 in linear regression models). Other differences did not reach statistical significance.


CONCLUSIONS
Based on physician report, Guided Care provides important benefits to physicians by improving communication with chronically ill older patients and their families and in physicians' knowledge of their patients' clinical conditions.
Marsteller
Jill A
JA
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. jmarstel@jhsph.edu
Hsu
Yea-Jen
YJ
Reider
Lisa
L
Frey
Katherine
K
Wolff
Jennifer
J
Boyd
Cynthia
C
Leff
Bruce
B
Karm
Lya
L
Scharfstein
Daniel
D
Boult
Chad
C
D000367:Age Factors; D000375:Aging; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D016000:Cluster Analysis; D003625:Data Collection; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D005791:Patient Care / Q000379:methods / Q000523:psychology*; D018802:Patient-Centered Care / Q000379:methods / Q000458:organization & administration; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States