Care Model Shores Up Satisfaction Among Elderly, Chronic Patients

CHICAGO — A primary care delivery model for older patients with multiple chronic illnesses increased physician understanding of the patients' clinical conditions and improved communication with patients and families, in a randomized trial at eight primary care practices.

The study findings, presented in a poster at the annual research meeting of AcademyHealth, add to a growing body of evidence that the model can improve outcomes, reduce costs, and enhance the quality of care for chronically ill older adults.

In the Guided Care model—an initiative developed by the Johns Hopkins Bloomberg School of Public Health, Baltimore—a Guided Care nurse works with three or four primary care physicians and a targeted population of 50-60 patients. The nurse receives additional training in patient education and coaching and in chronic disease management.

The nurse also develops a comprehensive care plan for each patient based on medical conditions, the home environment, and individual patient goals; monitors patients monthly; coordinates transitions between providers and sites of care; educates and supports caregivers; keeps an electronic health record; and provides physicians with detailed updates.

“Physicians don't have a lot of time to do these things for every one of their complex patients,” Jill Marsteller, Ph.D., noted in an interview. “The nurse helps very much in terms of having a close personal relationship with these people who are so complex, and can provide them with the guidance that they need to access community resources and help them keep track of all the different visits.” The nurse also summarizes the information for the physician.

The nurse visits the patient's home when Guided Care begins, making a connection that can yield valuable insights that might not come out in a medical interview.

A randomized trial of Guided Care has shown that this heightened attention to patients and support for physicians improves outcomes and increases patient satisfaction with their care. In the trial, 49 primary care physicians at eight community-based medical practices in the Baltimore and Washington region and 904 of their patients aged 65 years or older with multiple comorbidities were randomly assigned to Guided Care or usual care.

After 6 months, patients receiving Guided Care were twice as likely as patients receiving usual care to rate the quality of their care as high (J. Gerontol. A Biol. Sci. Med. Sci. 2008;63:321-7). After 8 months, Guided Care patients spent 24% fewer days in the hospital, and had 29% fewer home health visits and 15% fewer emergency department visits (Am. J. Manag. Care 2009;15:555-9).

The most recent phase of the study, presented at the AcademyHealth meeting, focused on physician satisfaction and perceptions after participating in the project for 1 year.

On a six-point scale ranging from “very dissatisfied” to “very satisfied,” physicians in the control group gave mean ratings of 4.25 and 3.94, at baseline and at 1 year, respectively, for satisfaction with patient/family communication, while physicians in the Guided Care group gave mean ratings of 4.03 and 4.40. On a four-point scale measuring clinical knowledge of patients, with responses ranging from “definitely not” to “definitely,” physicians in the control group gave mean ratings of 2.70 and 2.77 at baseline and 1 year, respectively, while physicians in the Guided Care group gave mean ratings of 2.85 and 3.17.

The study was funded by the John A. Hartford Foundation and the Roger C. Lipitz Center for Integrated Health Care of the Bloomberg School of Public Health.

CHICAGO — A primary care delivery model for older patients with multiple chronic illnesses increased physician understanding of the patients' clinical conditions and improved communication with patients and families, in a randomized trial at eight primary care practices.

The study findings, presented in a poster at the annual research meeting of AcademyHealth, add to a growing body of evidence that the model can improve outcomes, reduce costs, and enhance the quality of care for chronically ill older adults.

In the Guided Care model—an initiative developed by the Johns Hopkins Bloomberg School of Public Health, Baltimore—a Guided Care nurse works with three or four primary care physicians and a targeted population of 50-60 patients. The nurse receives additional training in patient education and coaching and in chronic disease management.

The nurse also develops a comprehensive care plan for each patient based on medical conditions, the home environment, and individual patient goals; monitors patients monthly; coordinates transitions between providers and sites of care; educates and supports caregivers; keeps an electronic health record; and provides physicians with detailed updates.

“Physicians don't have a lot of time to do these things for every one of their complex patients,” Jill Marsteller, Ph.D., noted in an interview. “The nurse helps very much in terms of having a close personal relationship with these people who are so complex, and can provide them with the guidance that they need to access community resources and help them keep track of all the different visits.” The nurse also summarizes the information for the physician.

The nurse visits the patient's home when Guided Care begins, making a connection that can yield valuable insights that might not come out in a medical interview.

A randomized trial of Guided Care has shown that this heightened attention to patients and support for physicians improves outcomes and increases patient satisfaction with their care. In the trial, 49 primary care physicians at eight community-based medical practices in the Baltimore and Washington region and 904 of their patients aged 65 years or older with multiple comorbidities were randomly assigned to Guided Care or usual care.

After 6 months, patients receiving Guided Care were twice as likely as patients receiving usual care to rate the quality of their care as high (J. Gerontol. A Biol. Sci. Med. Sci. 2008;63:321-7). After 8 months, Guided Care patients spent 24% fewer days in the hospital, and had 29% fewer home health visits and 15% fewer emergency department visits (Am. J. Manag. Care 2009;15:555-9).

The most recent phase of the study, presented at the AcademyHealth meeting, focused on physician satisfaction and perceptions after participating in the project for 1 year.

On a six-point scale ranging from “very dissatisfied” to “very satisfied,” physicians in the control group gave mean ratings of 4.25 and 3.94, at baseline and at 1 year, respectively, for satisfaction with patient/family communication, while physicians in the Guided Care group gave mean ratings of 4.03 and 4.40. On a four-point scale measuring clinical knowledge of patients, with responses ranging from “definitely not” to “definitely,” physicians in the control group gave mean ratings of 2.70 and 2.77 at baseline and 1 year, respectively, while physicians in the Guided Care group gave mean ratings of 2.85 and 3.17.

The study was funded by the John A. Hartford Foundation and the Roger C. Lipitz Center for Integrated Health Care of the Bloomberg School of Public Health.

CHICAGO — A primary care delivery model for older patients with multiple chronic illnesses increased physician understanding of the patients' clinical conditions and improved communication with patients and families, in a randomized trial at eight primary care practices.

The study findings, presented in a poster at the annual research meeting of AcademyHealth, add to a growing body of evidence that the model can improve outcomes, reduce costs, and enhance the quality of care for chronically ill older adults.

In the Guided Care model—an initiative developed by the Johns Hopkins Bloomberg School of Public Health, Baltimore—a Guided Care nurse works with three or four primary care physicians and a targeted population of 50-60 patients. The nurse receives additional training in patient education and coaching and in chronic disease management.

The nurse also develops a comprehensive care plan for each patient based on medical conditions, the home environment, and individual patient goals; monitors patients monthly; coordinates transitions between providers and sites of care; educates and supports caregivers; keeps an electronic health record; and provides physicians with detailed updates.

“Physicians don't have a lot of time to do these things for every one of their complex patients,” Jill Marsteller, Ph.D., noted in an interview. “The nurse helps very much in terms of having a close personal relationship with these people who are so complex, and can provide them with the guidance that they need to access community resources and help them keep track of all the different visits.” The nurse also summarizes the information for the physician.

The nurse visits the patient's home when Guided Care begins, making a connection that can yield valuable insights that might not come out in a medical interview.

A randomized trial of Guided Care has shown that this heightened attention to patients and support for physicians improves outcomes and increases patient satisfaction with their care. In the trial, 49 primary care physicians at eight community-based medical practices in the Baltimore and Washington region and 904 of their patients aged 65 years or older with multiple comorbidities were randomly assigned to Guided Care or usual care.

After 6 months, patients receiving Guided Care were twice as likely as patients receiving usual care to rate the quality of their care as high (J. Gerontol. A Biol. Sci. Med. Sci. 2008;63:321-7). After 8 months, Guided Care patients spent 24% fewer days in the hospital, and had 29% fewer home health visits and 15% fewer emergency department visits (Am. J. Manag. Care 2009;15:555-9).

The most recent phase of the study, presented at the AcademyHealth meeting, focused on physician satisfaction and perceptions after participating in the project for 1 year.

On a six-point scale ranging from “very dissatisfied” to “very satisfied,” physicians in the control group gave mean ratings of 4.25 and 3.94, at baseline and at 1 year, respectively, for satisfaction with patient/family communication, while physicians in the Guided Care group gave mean ratings of 4.03 and 4.40. On a four-point scale measuring clinical knowledge of patients, with responses ranging from “definitely not” to “definitely,” physicians in the control group gave mean ratings of 2.70 and 2.77 at baseline and 1 year, respectively, while physicians in the Guided Care group gave mean ratings of 2.85 and 3.17.

The study was funded by the John A. Hartford Foundation and the Roger C. Lipitz Center for Integrated Health Care of the Bloomberg School of Public Health.