Stakeholder Advisory Committee Meetings
The first annual meeting of the Guided Care Stakeholder Advisory Committee was held June 17, 2005 at the Johns Hopkins Bloomberg School of Public Health. The Stakeholders' suggestions and the staff's progress in implementing them are described below.
Suggestion #1: Increase the involvement of community social service agencies.
The relevant Area Agencies on Aging (AAAs) are now active partners in the project. They will assist in training the nurses, facilitating the nurses' access to community services, and describing the community resources available to older persons in the study.
Suggestion #2: Increase the involvement of "mainstream" (i.e., non-Hopkins related) primary care practices.
As a result of additional recruitment efforts, "mainstream" practices are now providing the majority of the experimental and control physicians and patients for the study.
Suggestion #3: Evaluate the effects of Guided Care on primary care practices and on nurses' satisfaction with their jobs.
With additional funding from the John A. Hartford Foundation, an expert in organizational behavior (Dr. Jill Marsteller) will collect qualitative and quantitative data to assess these important outcomes.
Suggestion #4: Increase the capacity to provide consistent training to subsequent cohorts of Guided Care nurses (to compensate for turnover during the study and to replicate the Guided Care training after the study).
With consultation from a new consultant in nursing education (Dr. Jean Giddens), we have recorded lectures and case vignettes to be used by nursing instructors in leading standardized case-based interactive seminars, workshops, practica and distance education to teach most components of the curriculum.
Suggestion #5: Obtain the perspectives of additional stakeholders on the Committee.
New members of the Committee include representatives of consumers (Jennie Chin Hansen, AARP), family caregivers (Rick Greene, National Family Caregiver Support Program), community service organizations (John Stewart, Baltimore AAA), the home care industry (Mary Lou Stricklin, VNA-OH and Joan Marren, VNS- NY), the disease management industry (Michael Montijo, American Healthways), and organized medicine (David Hellmann, American College of Physicians).
Suggestion #6: Establish a website for communication about the project.
See www.jhsph.edu/lipitzcenter/Guided%20Care/index.html or www.jhsph.edu/lipitzcenter and click on "Guided Care." We would like to post the roster of the Committee on the website, but we want to be sure that you are comfortable with your listing. Please let me know if you would like your listing revised.
Suggestion #7: Establish the date for next year's Committee meeting this year.
From the attached list, please send me the dates you are available to attend the 2006 one-day meeting in Baltimore. After we have established a date, my assistant, Adriane King, will coordinate the flights, lodging, and other logistics for the meeting.
We're now busily hiring nurses, finalizing the curriculum, developing software, and recruiting patients for the study. Soon we'll begin training the nurses so the Guided Care intervention can be in the field by Spring.
The second annual meeting of the Guided Care Stakeholder Advisory Committee was held August 4, 2006 at The Conference Center at the Maritime Institute, which is adjacent to Baltimore-Washington International (BWI) Airport. The primary topics for this year’s meeting were the adoptability of Guided Care, the “branding” of Guided Care, and the business model for diffusing Guided Care. Other suggestions addressed the ongoing research on Guided Care.
Provide essential information (in addition to the study’s primary outcomes) to help potential adopters make decisions about adopting Guided Care
- Satisfaction with Guided Care among physicians and office staff.
- Job satisfaction among Guided Care Nurses (GCNs).
- Detailed description of practices in which the study is being conducted.
Offer an “adoption package” and consulting services to potential adopters:
- Physicians, practice organizations.
- Nursing educators: e.g., schools of nursing, Advanced Generalist masters degree programs, the Case Management Society of America, others.
Develop options for integrating the functions of the Electronic Health Record (developed for Guided Care) into the existing data systems of potential adopters.
- Total electronic integration of the EHR functions into EMRs
- Link stand-alone EHR modules, e.g., Care Guide generation, to EMRs
- Stand-alone EHR
Communicate the potential advantages of Guided Care to opinion leaders among insurers, primary care practices (of different sizes), nurses, and consumers.
- Website – descriptions, anecdotes, testimonials, video clips, etc.
- Published information
- Presentations at conferences
Brand must convey consistency in structure and results
Adopters must get GC quality regardless of environment in which it is delivered
We’ll need to demonstrate the replicability of the GC outcomes, including:
- People are accountable for processes and outcomes in replications of GC
- GCN job satisfaction remains high in replications of GC
- Pool of eligible nurses is available for replications of GC
- Practices satisfied with GC after adoption
- Describe practices, including staff turnover and specific
Business model suggestions
Calculate the amount CMS would pay Medicare Advantage plans (based on HCC values) for the care of GC patients.
Consider proposing a shared savings model with CMS.
Consider the “care coordinator model” proposed by MedPAC.
Research suggestions to increase the likelihood of diffusion:
Characterize the patients who declined to participate, consider going back and, through surveys, determining why they declined.
Characterize practice, physician and nurse satisfaction using instruments that can be compared to national benchmarks.
Study the On-Lok diffusion model for ideas in how to diffuse GC.