AHRQ Awards Funding to Evaluate Continued Savings of Guided Care Intervention

The Agency for Healthcare Research and Quality (AHRQ) has awarded a $100,000 grant to the Johns Hopkins Bloomberg School of Public Health to study the ongoing cost effectiveness of Guided Care, a model of proactive, comprehensive health care provided by physican-nurse teams for people with chronic health conditions. This new funding will enable Chad Boult, MD, MPH, MBA, the principal investigator of the study and creator of the Guided Care model, and his research team to evaluate the cumulative effects of Guided Care in the final year of a 32-month randomized controlled trial (RCT).

Research already suggests that chronically ill patients use less health care resources when they are closely supported by a Guided Care nurse-physician primary care team that tracks their health and offers regular support. In the first eight months of the RCT, patients in the Guided Care program spent less time in hospitals and skilled nursing facilities and had fewer emergency room visits and home health episodes, resulting in an annual net savings of $75,000 per Guided Care nurse. The additional research phase will assess the ongoing effects of Guided Care on the patient’s use of high-cost services, the insurers’ net costs for health care, and the cost of care for certain subgroups of chronically ill older persons during the final year of the RCT.

“In the early stages of the program, Guided Care patients cost health insurers 11 percent less than patients in the control group,” said Dr. Boult. “With the new AHRQ funding, we will evaluate savings and utilization in the later stages, when the care team’s relationships are established and the patient’s conditions have been managed over a longer period of time.”

Dr. Boult will present on the Guided Care program at today’s AHRQ Annual Conference during the session titled “Linking Clinical Practices and Community Resources to Improve Health Care: Innovative Approaches.”

A recently published study in the American Journal of Managed Care showed that on average, Guided Care patients experienced 24 percent fewer hospital stays, 37 percent fewer skilled nursing facility days, 15 percent fewer emergency department visits and 29 percent fewer home health care episodes compared to patients who received usual care. Other analyses have shown that Guided Care improves the quality of patients’ care, reduces family caregiver strain, and improves physicians’ satisfaction with chronic care.

The Guided Care model is designed to improve patients’ quality of life and care, while improving the efficiency of treating the sickest and most complex patients. The care teams include a registered nurse, two to five physicians and other members of the office staff who work closely together for the benefit of each patient.

A multi-site randomized controlled trial of Guided Care involving 49 physicians, 904 older patients, and 308 family caregivers recently concluded in eight locations in the Baltimore-Washington D.C. area. The three-year study was funded by a public-private partnership of the Agency for Healthcare Research and Quality, the National Institute on Aging, the John A. Hartford Foundation, the Jacob and Valeria Langeloth Foundation, Kaiser Permanente Mid-Atlantic States, Johns Hopkins Healthcare, and the Roger C. Liptiz Center for Integrated Healthcare.

About Guided Care

The Guided Care model was developed by a team of clinical researchers at Johns Hopkins University beginning in 2001. The team is supported by a Stakeholder Advisory Committee, comprised of national leaders in medicine, nursing, health policy, patient advocacy and health insurance. Some have said that Guided Care and its attention to the often overwhelming medical and non-medical needs of these patients is like “having a nurse in the family.” For more information, please go to: www.GuidedCare.org.

About the Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality’s (AHRQ) mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Information about AHRQ’s research helps people make more informed decisions and improve the quality of health care services. AHRQ was formerly known as the Agency for Health Care Policy and Research. For more information, go to www.ahrq.gov.

About the John A. Hartford Foundation

Founded in 1929, the John A. Hartford Foundation is a committed champion of training, research and service system innovations that promote the health and independence of America's older adults. Through its grantmaking, the Foundation seeks to strengthen the nation's capacity to provide effective, affordable care to this rapidly increasing older population by educating "aging-prepared" health professionals (physicians, nurses, social workers), and developing innovations that improve and better integrate health and supportive services. The Foundation was established by John A. Hartford. Mr. Hartford and his brother, George L. Hartford, both former chief executives of the Great Atlantic & Pacific Tea Company, left the bulk of their estates to the Foundation upon their deaths in the 1950's. Additional information about the Foundation and its programs is available at www.jhartfound.org.