Improving chronic disease care by adding laypersons to the primary care team: a parallel randomized trial.
BACKGROUND
Improving the quality and efficiency of chronic disease care is an important goal.


OBJECTIVE
To test whether patients with chronic disease working with lay "care guides" would achieve more evidence-based goals than those receiving usual care.


METHODS
Parallel-group randomized trial, stratified by clinic and conducted from July 2010 to April 2012. Patients were assigned in a 2:1 ratio to a care guide or usual care. Patients, providers, and persons assessing outcomes were not blinded to treatment assignment. (ClinicalTrials.gov: NCT01156974).


METHODS
6 primary care clinics in Minnesota.


METHODS
Adults with hypertension, diabetes, or heart failure.


METHODS
2135 patients were given disease-specific information about standard care goals and asked to work toward goals for 1 year, with or without the help of a care guide. Care guides were 12 laypersons who received brief training about these diseases and behavior change.


METHODS
The primary end point for each patient was change in percentage of goals met 1 year after enrollment.


RESULTS
The percentage of goals met increased in both the care guide and usual care groups (changes from baseline, 10.0% and 3.9%, respectively). Patients with care guides achieved more goals than usual care patients (82.6% vs. 79.1%; odds ratio, 1.31 [95% CI, 1.16 to 1.47]; P < 0.001); reduced unmet goals by 30.1% compared with 12.6% for usual care patients; and improved more than usual care patients in meeting several individual goals, including not using tobacco. Estimated cost was $286 per patient per year.


CONCLUSIONS
Providers' usual care may have been influenced by contact with care guides. Last available data in the electronic health record were used to assess end points.


CONCLUSIONS
Adding care guides to the primary care team can improve care for some patients with chronic disease at low cost.
Allina Health and the University of Minnesota, Minneapolis, Minnesota, USA.
Richard
R
Adair
Douglas R
DR
Wholey
Jon
J
Christianson
Katie M
KM
White
Heather
H
Britt
Suhna
S
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D000488:Allied Health Personnel / Q000191:economics; D001521:Behavior Therapy; D002908:Chronic Disease / Q000191:economics / Q000628:therapy*; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods*; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006040:Goals; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010348:Patient Care Team / Q000191:economics; D011320:Primary Health Care / Q000191:economics / Q000379:methods*; D055815:Young Adult