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The newspaper of The Johns Hopkins University July 25, 2005 | Vol. 34 No. 40
Guided Care Study Launched to Aid Seniors with Chronic Conditions

By Tim Parsons
School of Public Health

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 study.

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 community services.

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 medical conditions."

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.


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