Annual population analyses showed demographic and morbidity characteristics of the 28,000 patients. Mean ACG risk scores by primary care site, number of chronic conditions, and prevalence of chronic disease compared to national US benchmarks showed that morbidity is high in the US Family Health Plan population.
In 2006, we began a cluster-randomized, controlled trial of Guided Care in the mid-Atlantic region of the United States. This study was designed to measure the effects of GC on the quality of care for a multi-morbid population with high-risk scores on the outcomes of care for patients, families, primary-care practices, physicians, nurses, and healthcare insurers.
We hypothesized that 1) GC would improve patients' quality of care and physicians' satisfaction with care within 6 months, and 2) better quality of care would secondarily lead to improvements in patients' quality of life and efficiency of resource use - as well as to desirable outcomes for other stakeholders in chronic care.
Preliminary data indicated that Guided Care:
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1)
Improves the quality of patients' care. (After six months, GC patients were twice as likely as regular-care patients to rate the quality of their care highly. After 20 months, GC patients were more than twice as likely as regular-care patients to rate the quality of their care highly).
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2)
Reduces the use and cost of expensive services. (After the first eight months of the study, GC patients experienced, on average, 24% fewer hospitals days, 37% fewer skilled nursing facility days, 15% fewer emergency department visits, and 29% fewer home healthcare episodes. GC patients also experienced 9% more specialist visits; however, this is not considered statistically significant. Based on current Medicare payment rates, and GC costs, these differences in utilization produce net savings for healthcare payors.)
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3)
Reduces family caregiver strain. (After six months, the GC caregivers' "strain" and "depression" scores were lower than the comparison (regular care) caregivers' scores, especially among caregivers who provided more than 14 hours of weekly assistance.
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4)
Improves physicians' satisfaction with chronic care. (Compared to the physicians in the control group, the physicians who practiced GC for a year rated their satisfaction with patient/family communication, and their knowledge of their chronically-ill patients' clinical conditions, significantly higher.