Researchers at the
Johns Hopkins Bloomberg School of Public Health have
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 in June at the Bloomberg School. Rep.
Benjamin L. Cardin (D-Md.) 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," said Chad Boult, a professor in the
Department of Health Policy and Management at the
Bloomberg School and leader of the team that developed
Guided Care. "Unfortunately, the current provider-centered
health care system is fragmented and difficult to navigate
for people with multiple chronic conditions.
"In the words of the Institute of Medicine, the system
is 'a nightmare to navigate,'" he said. "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," said
Boult, who is also director of the Roger C. Lipitz Center
for Integrated Health Care, which will oversee the
Guided Care is designed to improve the quality of life
for older Americans with complex health care needs, while
increasing the efficiency of care, Boult said. In Guided
Care, a specially trained registered nurse helps two to
four primary care physicians 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, smooths
transitions between sites of care and facilitates access to
Sen. Barbara A. Mikulski (D-Md.) said of the
initiative, "I believe that 'Honor Thy Mother and Father'
is a good commandment to live by and a good policy to
govern by. 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," Cardin said. "The Guided Care
study will help determine better ways to manage and improve
the quality of life for those with multiple, chronic
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.
The 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 and the Jacob and
Valeria Langeloth Foundation.