Guided Care model for older complex patients wins praise

Under the plan, a nurse in a primary care office works with physicians to monitor 50 to 60 of the most complex patients.

By Susan J. Landers — Posted July 2, 2009

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

A new model of care has received kudos from primary care physicians and patients for its ability to provide cost-effective and high-quality care to older patients who have several chronic conditions.

The model, called Guided Care, was developed by researchers at Johns Hopkins Bloomberg School of Public Health in Baltimore. The researchers said it is comparable to the patient-centered medical home supported by the AMA and many other physician groups. Features of the Guided Care model were provided during a June 17 Capitol Hill briefing to the Congressional Biomedical Research Caucus by Chad Boult, MD, MPH, director of the Roger C. Lipitz Center for Integrated Health Care at Johns Hopkins.

In the model, a registered nurse based in a primary care office works with three to four physicians to closely monitor 50 to 60 chronically ill patients age 65 and older.

The nurse develops a comprehensive care plan that takes into consideration patients' medical conditions and home situations. The nurse also works with a patient's caregivers, usually family members.

Patients receive a copy of the plan covering a range of items, including optimal physical activity and blood-pressure monitoring. The patient and nurse talk monthly, often by phone, about care.

A randomized controlled trial of Guided Care in eight community-based primary care practices in the Baltimore-Washington, D.C., region found that patients in the program were twice as likely to rate the quality of care as high, compared with the patients in standard care.

Physicians who practiced Guided Care for a year rated their satisfaction with patient and family communication and knowledge of patients' clinical conditions significantly higher than did physicians in the control group, Dr. Boult said. Participating physicians said the model saved time and allowed for more valuable interactions with patients, who came to appointments with a better understanding of their conditions.

The model also provided considerable cost savings -- about $75,000 net savings per nurse per year -- Dr. Boult said.

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn