Guided Care Study Launched to Aid Seniors with Chronic Conditions

Researchers at the Johns Hopkins Bloomberg School of Public Health announced the launch of a five-year study of a new approach to health care for older people with multiple chronic conditions. The “Guided Care” study will place specially trained registered nurses in primary care practices in the Baltimore-Washington area and northern Virginia. The nurses will help physicians improve the quality of life for their patients and families and reduce health care costs. The study was officially announced at a news conference held June 17, 2005, at the Bloomberg School of Public Health. Rep. Benjamin L. Cardin (D-Maryland) and top leaders of the U.S. Agency for Healthcare Research and Quality, the National Institute on Aging, and the John A. Hartford Foundation were on hand for the announcement.

“As Americans live longer, many develop chronic conditions, such as diabetes, arthritis, asthma and hypertension that require complex and coordinated health care. Unfortunately, the current provider-centered health care system is fragmented and difficult to navigate for people with multiple chronic conditions,” said Chad Boult, MD, MPH, MBA, a professor in the Department of Health Policy and Management at the Bloomberg School. Boult led the team that developed Guided Care.

“In the words of the Institute of Medicine, the system is ‘a nightmare to navigate.’ As a result, quality of life suffers for these people and their families, and health care costs are extremely high. We conducted a small pilot study of Guided Care last year, which led to improved care for older people with chronic conditions and substantial savings in medical costs,” added Boult, who is also director of the Roger C. Lipitz Center for Integrated Health Care, which will oversee the study.

According to Boult, Guided Care is designed to improve the quality of life for older Americans with complex health care needs, while increasing the efficiency of care. In Guided Care, a specially trained registered nurse helps two to four primary care physicians to provide coordinated, comprehensive health care for chronically ill older patients. Equipped with information technology, the nurse assesses the patient’s health status and preferences, creates a comprehensive, evidence-based care plan, and coordinates the efforts of all the patient’s health care professionals. The nurse also educates and coaches patients and families, monitors chronic conditions, smoothes transitions between sites of care and facilitates access to community services.

“I believe that Honor Thy Mother and Father is a good commandment to live by and a good policy to govern by," said Senator Barbara A. Mikulski (D-Maryland). “Guided Care is about developing innovative solutions and using best practices to help our seniors with chronic conditions live longer, healthier and richer lives. I am so proud to have worked to get our best and brightest, the minds at Johns Hopkins Bloomberg School of Public Health, a federal investment in a large-scale evaluation of this promising study.”

“The U.S. health care system needs to develop a much more efficient delivery system for older Americans with complex health care needs. The Guided Care study will help determine better ways to manage and improve the quality of life for those with multiple, chronic medical conditions,” said Congressman Cardin.

Boult and his colleagues will conduct a rigorous test of Guided Care at nine Johns Hopkins Community Physicians and Kaiser Permanente health centers in the Baltimore-Washington-northern Virginia area over the next five years. This randomized study will measure the effects of Guided Care on the quality of life of patients and families, and on their overall health care costs. Consultants and national leaders in health policy, consumer advocacy, health insurance and health care delivery will help shape the study and, if the results are favorable, speed the adoption of Guided Care throughout the American health care system.

Karen Kleiner, whose mother, Dolores Smyth, participated in the Guided Care pilot study, said “Having a Guided Care nurse took a burden off us. Any time we called our nurse with questions, she handled the situation professionally and was able to either resolve the problem or point us in the correct direction. This made our experience with the health care system more satisfying for us and more efficient for the system overall. Having a Guided Care nurse saved us time and energy and gave us peace of mind.”

The Guided Care study is supported by grants from the U.S. Agency for Healthcare Research and Quality, the National Institute on Aging, the John A. Hartford Foundation of New York City and the Jacob and Valeria Langeloth Foundation.