Effects of Guided Care on Family Caregivers

Wolff, Jennifer L.; Giovannetti, Erin R.; Boyd, Cynthia M.; Reider, Lisa; Palmer, Sylvain; Scharfstein, Daniel O.; Marsteller, Jill A.; Wegener, Stephen T.; Frey, Katherine; Leff, Bruce; Frick, Kevin D.; Boult, Chad

doi:10.1093/geront/gnp124

Cited by 62 publications

(87 citation statements)

References 42 publications

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“…28 Other analyses have shown that Guided Care improves primary care physicians' satisfaction with some aspects of chronic care, 29,30 and family caregivers' ratings of the quality of chronic care. 31 Several factors may underlie the observed lack of significant effect on patients' functional health and use of some health services: inadequate potency of the initial version of the Guided Care model tested, the considerable heterogeneity in the implementation of the model by the individual nurses and physicians on the seven different intervention teams, and inadequate statistical power to draw inferences about the intervention's effects on health care utilization. A much larger number of pods would have been needed to determine whether Guided Care accounted for the observed reductions in hospital admissions, 30-day hospital re-admissions and skilled nursing facility days.…”

Section: Discussionmentioning

confidence: 99%

A Matched-Pair Cluster-Randomized Trial of Guided Care for High-Risk Older Patients

et al. 2013

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BACKGROUND: Patients at risk for generating high health care expenditures often receive fragmented, lowquality, inefficient health care. Guided Care is designed to provide proactive, coordinated, comprehensive care for such patients. OBJECTIVE: We hypothesized that Guided Care, compared to usual care, produces better functional health and quality of care, while reducing the use of expensive health services. DESIGN: 32-month, single-blind, matched-pair, cluster-randomized controlled trial of Guided Care, conducted in eight community-based primary care practices. PATIENTS: The "Hierarchical Condition Category" (HCC) predictive model was used to identify high-risk older patients who were insured by fee-for-service Medicare, a Medicare Advantage plan or Tricare. Patients with HCC scores in the highest quartile (at risk for generating high health care expenditures during the coming year) were eligible to participate. INTERVENTION: A registered nurse collaborated with two to five primary care physicians in providing eight services to participants: comprehensive assessment, evidence-based care planning, proactive monitoring, care coordination, transitional care, coaching for selfmanagement, caregiver support, and access to community-based services. MAIN MEASURES: Functional health was measured using the Short Form-36. Quality of care and health services utilization were measured using the Patient Assessment of Chronic Illness Care and health insurance claims, respectively. KEY RESULTS: Of the eligible patients, 904 (37.8 %) gave written consent to participate; of these, 477 (52.8 %) completed the final interview, and 848 (93.8 %) provided complete claims data. In intention-to-treat analyses, Guided Care did not significantly improve participants' functional health, but it was associated with significantly higher participant ratings of the quality of care (difference=0.27, 95 % CI=0.08-0.45) and 29 % lower use of home care (95 % CI=3-48 %). CONCLUSIONS: Guided Care improves high-risk older patients' ratings of the quality of their care, and it reduces their use of home care, but it does not appear to improve their functional health.

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Section: Discussionmentioning

confidence: 99%

A Matched-Pair Cluster-Randomized Trial of Guided Care for High-Risk Older Patients

et al. 2013

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“…In the Guided Care model, primary care physician satisfaction was higher at the 6-month follow-up among intervention group healthcare providers, 59 and at 18 months, intervention patients rated their care higher, used home health care less frequently, and had fewer nursing facility admissions. 61 When caregiver depression, strain, work productivity, and regular activity productivity were studied at 18 months 63 and patient self-rated health, mortality, and several other healthcare use measures were studied at 32 months, 61 no between-group differences were found. Results of miscellaneous outcomes must be interpreted with caution because blinding of groups was not feasible.…”

Section: Other Outcomesmentioning

confidence: 99%

Transitions of Care in Heart Failure

Albert¹,

Barnason²,

Deswal³

et al. 2015

Circ: Heart Failure

215

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In patients with heart failure (HF), use of 30-day rehospitalization as a healthcare metric and increased pressure to provide value-based care compel healthcare providers to improve efficiency and to use an integrated care approach. Transition programs are being used to achieve goals. Transition of care in the context of HF management refers to individual interventions and programs with multiple activities that are designed to improve shifts or transitions from one setting to the next, most often from hospital to home. As transitional care programs become the new normal for patients with chronic HF, it is important to understand the current state of the science of transitional care, as discussed in the available research literature. Of transitional care reports, there was much heterogeneity in research designs, methods, study aims, and program targets, or they were not well described. Often, programs used bundled interventions, making it difficult to discuss the efficiency and effectiveness of specific interventions. Thus, further HF transition care research is needed to ensure best practices related to economically and clinically effective and feasible transition interventions that can be broadly applicable. This statement provides an overview of the complexity of HF management and includes patient, hospital, and healthcare provider barriers to understanding end points that best reflect clinical benefits and to achieving optimal clinical outcomes. The statement describes transitional care interventions and outcomes and discusses implications and recommendations for research and clinical practice to enhance patient-centered outcomes.

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“…Family caregivers' reports of the quality of the chronic illness care provided to their care recipients were higher with guided care than with usual care after 18 months of followup (aβ = 0.40; 95 % CI = 0.14-0.67), a difference that was statistically signifi cant ( p < 0.001) [ 12 ].…”

Section: Resultsmentioning

confidence: 92%