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Guided Care
Guided Care is a model of proactive, comprehensive health care for people with several chronic conditions. A form of medical home, the model has been developed and tested by a multidisciplinary team of experts at the Roger C. Lipitz Center for Integrated Health Care〔http://www.jhsph.edu/lipitzcenter/Guided_Care/index.html〕 in the Johns Hopkins Bloomberg School of Public Health. Guided Care is provided by physician-nurse teams in primary care practices to the physicians’ most complex patients, mainly older adults with chronic conditions and complicated health needs. It is designed to increase patients’ quality of care and quality of life, while improving the efficiency of their use of health care resources, thus reducing their overall health care costs.
In Guided Care, a registered nurse based in a primary care office works closely with three to four physicians to provide state-of-the-art chronic care for 50-60 chronically ill patients. Following a comprehensive assessment and an evidence-based care planning process, the Guided Care nurse monitors patients, promotes self-management, smooths transitions between sites of care, educates and supports family caregivers, facilitates access to community resources, and coordinates the efforts of health care professionals, hospitals and community agencies to avoid duplication and conflicting advice. The goal is to ensure that no important health-related needs are overlooked.〔Boyd CM, Boult C, Shadmi E, Leff B, Brager R, Dunbar L, Wolff JL, Wegener S, "Guided Care for Multimorbid Older Adults," ''The Gerontologist'', 2007;47(5):697-704〕
==The Studies==
The Guided Care model was first tested in a pilot study in the Baltimore-Washington D.C. area during 2003-2004. Patients who received Guided Care rated their quality of care significantly more highly than patients who received usual care,〔Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, Sylvia M, Boult C, "A Pilot Test of the Effect of Guided Care on the Quality of Primary Care Experiences for Multi-Morbid Older Adults," ''Journal of General Internal Medicine'', 2008;23(5):536-42〕 and the average insurance costs for Guided Care patients were 23 percent lower over a six-month period.〔Sylvia M, Griswold M, Dunbar L, Boyd CM, Park M, Boult C, "Guided Care: Cost and Utilization Outcomes in a Pilot Study," ''Disease Management'', 2008;11(1):29-36〕
In 2005, the Lipitz Center secured grant funding from the John A. Hartford Foundation,〔http://www.jhartfound.org/v1i2.htm〕 the Agency for Healthcare Research and Quality, the National Institute on Aging, and the Jacob and Valeria Langeloth Foundation to conduct a cluster randomized controlled trial (RCT) in eight community-based primary care practices in the Baltimore-Washington D.C. region. More than 900 patients, 300 caregivers, and 50 primary care physicians participated; all patients were 65 years or older.〔Leff B, Reider L, Frick KD, Scharfstein DD, Boyd CM, Frey K, Karm L, Boult C, "Guided Care and the Cost of Complex Healthcare: A Preliminary Report," ''American Journal of Managed Care'', 2009;15(8):555-559〕 The primary objective was to evaluate the effects of Guided Care on the quality, efficiency and clinical outcomes of health care for chronically ill older patients and their family caregivers. Patients were divided into two groups – one group received Guided Care and the other group received ‘usual care’.〔Boult C, Karm L, Groves C, "Improving Chronic Care: The 'Guided Care' Model," ''The Permanente Journal'', Winter 2008;12(1):50-54〕 Researchers measured the effects of Guided Care on the patients, their families, their health care providers, and their health care insurers. The trial was conducted from May 2006 through June 2009.
抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』
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