title: The effect of guided care teams on the use of health services: results from a cluster-randomized controlled trial.
abstract: BACKGROUND
  The effect of interdisciplinary primary care teams on the use of health services by patients with multiple chronic conditions is uncertain. This study aimed to measure the effect of guided care teams on multimorbid older patients' use of health services.
  
  
  METHODS
  Eligible patients from 3 health care systems in the Baltimore, Maryland-Washington, DC, area were cluster-randomized to receive guided care or usual care for 20 months between November 1, 2006, and June 30, 2008. Eight services of a guided care nurse working in partnership with patients' primary care physicians were provided: comprehensive assessment, evidence-based care planning, monthly monitoring of symptoms and adherence, transitional care, coordination of health care professionals, support for self-management, support for family caregivers, and enhanced access to community services. Outcome measures were frequency of use of emergency departments, hospitals, skilled nursing facilities, home health agencies, primary care physician services, and specialty physician services.
  
  
  RESULTS
  The study included 850 older patients at high risk for using health care heavily in the future. The only statistically significant overall effect of guided care in the whole sample was a reduction in episodes of home health care (odds ratio, 0.70; 95% confidence interval, 0.53-0.93). In a preplanned analysis, guided care also reduced skilled nursing facility admissions (odds ratio, 0.53; 95% confidence interval, 0.31-0.89) and days (0.48; 0.28-0.84) among Kaiser-Permanente patients.
  
  
  CONCLUSIONS
  Guided care reduces the use of home health care but has little effect on the use of other health services in the short run. Its positive effect on Kaiser-Permanente patients' use of skilled nursing facilities and other health services is intriguing. Trial Registration clinicaltrials.gov Identifier: NCT00121940.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 693, Baltimore, MD 21205, USA. tnovak@jhsph.edu
authors.forename: Chad
authors.initials: C
authors.lastname: Boult
authors.forename: Lisa
authors.initials: L
authors.lastname: Reider
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Boyd
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wolff
authors.forename: Katherine
authors.initials: K
authors.lastname: Frey
authors.forename: Lya
authors.initials: L
authors.lastname: Karm
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Wegener
authors.forename: Tracy
authors.initials: T
authors.lastname: Mroz
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Scharfstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore; D002908:Chronic Disease; D016000:Cluster Analysis; D003695:Delivery of Health Care; D004219:District of Columbia; D005260:Female; D006296:Health Services / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D005791:Patient Care / Q000191:economics / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration / Q000706:statistics & numerical data; D012866:Skilled Nursing Facilities / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D016896:Treatment Outcome