The quality of health care for older Americans with chronic conditions is suboptimal. Boyd and coworkers sought to evaluate the effects of "Guided Care" on patient-reported quality of chronic illness care. The study consisted of a cluster-randomized controlled trial of Guided Care in 14 primary care teams. Older patients of these teams were eligible to participate if, based on analysis of their recent insurance claims, they were at risk for incurring high health-care costs during the coming year. Small teams of physicians and their at-risk older patients were randomized to receive either Guided Care (GC) or usual care (UC). "Guided Care" is designed to enhance the quality of health care by integrating a registered nurse, trained in chronic care, into a primary care practice to work with 2-5 physicians in providing comprehensive chronic care to 50-60 multi-morbid older patients. Eighteen months after baseline, interviewers blinded to group assignment administered the Patient Assessment of Chronic Illness Care (PACIC) survey by telephone. Logistic and linear regression was used to evaluate the effect of the intervention on patient-reported quality of chronic illness care. Of the 13,534 older patients screened, 2,391 (17.7%) were eligible to participate in the study, of which 904 (37.8%) gave informed consent and were cluster-randomized. After 18 months, 95.3% and 92.2% of the GC and UC recipients who remained alive and eligible completed interviews. Compared to UC recipients, GC recipients had twice greater odds of rating their chronic care highly (p = 0.003).

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that Guided Care improves self-reported quality of chronic health care for multi-morbid older persons.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: This was a large-scale study. Adding more outcome measures, as well as self-management training, would likely have produced stronger results. Improving the study in this manner could have also reduced costs of health care sharply.

CM Boyd et al. The Effects of Guided Care on the Perceived Quality of Health Care for Multi-morbid Older Persons: 18-Month Outcomes from a Cluster-Randomized Controlled Trial. Journal of General Internal Medicine, December 22, 2009.