Almost a year has passed since the GHS and the Archstone Foundation recognized Guided Care with the 2008 Award for Excellence in Program Innovation, and what an exciting year it has been!  Scientific studies show that Guided Care improves the quality of care and suggest that it reduces overall health care costs, thereby generating much interest from health care providers, insurers, and federal policy-makers.  In response, many resources are now available to help practices adopt Guided Care.  Adding to that enthusiasm, Guided Care has been selected as the winner of the 2009 Medical Economics Award for Innovation in Practice Improvement co-sponsored by the Society of Teachers of Family Medicine, the American Academy of Family Physicians, and Medical Economics magazine.

Guided Care is a model of proactive, comprehensive health care provided by physician-nurse teams for people with several chronic health conditions. It is a type of medical home for the growing number of older adults with chronic health conditions. This model is designed to improve patients’ quality of life and care, while improving the efficiency of treating the sickest and most complex patients. Each care team includes a registered nurse, two to five physicians, and other members of the office staff who work together for the benefit of 50-60 patients to:

• Perform a comprehensive assessment at home.
• Create an evidence-based care guide and action plan.
• Monitor and coach the patient monthly.
• Coordinate the efforts of all the patient’s health care providers.
• Smooth the patient’s transition between sites of care.
• Promote patient self-management.
• Educate and support family caregivers.
• Facilitate access to appropriate community resources.    

A multi-site, randomized controlled trial of Guided Care involving 49 physicians, 904 older patients and 308 family caregivers recently concluded in eight locations in the Baltimore-Washington, D.C. area. The three-year study was funded by a public-private partnership of the Agency for Healthcare Research and Quality, the National Institute on Aging, the John A. Hartford Foundation, the Jacob and Valeria Langeloth Foundation, Kaiser Permanente Mid-Atlantic States, Johns Hopkins HealthCare, and the Roger C. Lipitz Center for Integrated Health Care.

Results from the Guided Care randomized trial show that the model improved patients’ quality of care, reduced family caregiver strain, and produced high job satisfaction among participating nurses and physicians.  New data indicate that Guided Care appears to reduce medical costs, resulting in an annual $1,364 savings per patient.  Compared to patients who received usual care, Guided Care patients experienced, on average, 24 percent fewer hospital days, 37 percent fewer skilled nursing facility days, 15 percent fewer emergency department visits, and 29 percent fewer home health care episodes.

“Guided Care patients cost health insurers 11 percent less than patients in the control group,” says Chad Boult, MD, MPH, MBA, the principal investigator of the study and the Eugene and Mildred Lipitz Professor in Health Care Policy at the Johns Hopkins Bloomberg School of Public Health.  “If you apply that rate of savings to the 11 million eligible Medicare beneficiaries, programs like Guided Care could potentially save Medicare more than $15 billion every year.”

Guided Care is a type of medical home where the physician-nurse team provides comprehensive, coordinated care to patients, the patients get involved in their own care, and the nurse tracks everything that happens to the patient.  It is different from a typical medical home in that Guided Care only focuses on the high-risk patients, or the top 25 percent of patients with complex conditions.

“To implement a typical medical home, you really have to transform the whole practice and how everything gets done.” says Dr. Boult.  “It could take years to put such a comprehensive type of medical home into place.  In contrast, Guided Care is fairly easy to implement.  You hire a registered nurse, put her through the Guided Care Nursing online course, integrate her into the practice, and you are running.” 

With funding from the John A. Hartford Foundation, resources were developed and are now available to help practices adopt Guided Care.  The book “Guided Care: A New Nurse-Physician Partnership in Chronic Care” is an implementation manual with many lessons learned, tools, and resources from the randomized trial.  The Lipitz Center also provides: guidance on selecting health information technology, an online course for physicians and other practice leaders, and an online course for registered nurses in Guided Care Nursing.  Nurses who successfully complete it will be eligible for a Certificate in Guided Care Nursing from the American Nurses Credentialing Center of the American Nurses Association.  In addition, practices will be able to participate in ongoing learning communities and obtain individual consultation as desired.

For more information, please visit http://www.GuidedCare.org for details about Guided Care and http://www.MedHomeInfo.org for resources on becoming a Guided Care medical home.