1 / 18

Guided Care: Evidence of Cost-Effectiveness

Guided Care: Evidence of Cost-Effectiveness. Chad Boult, MD, MPH, MBA Professor of Public Health, Medicine and Nursing Johns Hopkins University PCPCC Annual Summit Washington DC October 22, 2009. “Guided Care”. A patient-centered medical home for patients with several chronic conditions.

virote
Download Presentation

Guided Care: Evidence of Cost-Effectiveness

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Guided Care:Evidence of Cost-Effectiveness Chad Boult, MD, MPH, MBA Professor of Public Health, Medicine and Nursing Johns Hopkins University PCPCC Annual Summit Washington DC October 22, 2009

  2. “Guided Care” A patient-centered medical home for patients with several chronic conditions

  3. What is Guided Care Look Like? A practice-based RN collaborates with 2-5 physicians in caring for 50-60 of their most complex patients.

  4. Nurse/physician team Assesses needs and preferences Creates an evidence-based “care guide” and a patient-friendly “action plan” Monitors the patient proactively Supports chronic disease self-management Smoothes transitions between caresites Communicates with providers in EDs, hospitals, specialty clinics, rehab facilities, home care agencies, hospice programs, and social service agencies in the community Educates and supports caregivers Facilitates access to community services Boyd et al. Gerontologist Nov 2007

  5. Who is Eligible? All Patients Age 65+ 25% High-Risk 75% Low-Risk Review previous year’s claims data with PM software

  6. Randomized Trial High-risk older patients (n=904) of 49 community-based primary care physicians practicing in 14 teams Physician/patient teams randomly assigned to receive Guided Care or “usual” care Outcomes measured at 8, 20 and 32 months

  7. Baseline Characteristics

  8. Effects on Physician Satisfaction p=0.008 p=0.066 p=0.006 p=0.034 p=0.047

  9. Effects on Quality of Care PACIC scales 2.1 AGGREGATE 1.3 Activation 1.3 Problem Solving 1.5 Decision Support 1.8 Coordination 1.5 Goal Setting Quality rated in the highest category on PACIC Adjusted for participants’ baseline age, race, sex, educational level, financial status, habitation status, HCC score, functional ability (i.e., SF-36 physical component summary and mental component summary scores), subscale-specific baseline PACIC score, satisfaction with health care, and practice site.

  10. Very satisfied Satisfied Somewhat satisfied Somewhat dissatisfied Dissatisfied Very dissatisfied Satisfaction Items 1= Familiarity with patients 2= Stability of patient relationships 3= Comm. w/ patients; availability of clinical info; continuity of care for patients 4= Efficiency of office visits; access to evidence based guidelines 5= Monitoring patients; communicating w/ caregivers; efficiency of primary care team 6= Coordinating care; referring to community resources; educating caregivers 7= Motivating patients for self management

  11. Very Satisfied Satisfied Somewhat Satisfied Somewhat Dissatisfied Dissatisfied Very Dissatisfied Satisfaction Items 1= Autonomy/flexibility; overall satisfaction 2= Client interaction 3= Diversity of tasks; amount of challenge 4= Relationship with PCPs 5= Interaction with coworkers; manageability of workload 6= Relationship with other physicians

  12. Effects on Caregiver Strain

  13. Annual Costs of Guided Care

  14. Effects on Costs of Care(per caseload, 55 patients)

  15. How Well Does Guided Care Work? A pilot test and a multi-site RCT show: • Improved quality of care • Improved physician satisfaction with care • Reduced strain for family caregivers • High job satisfaction for nurses • Cost savings for insurers Sylvia M et al. Dis Manag Feb 2008 Boyd C et al. J Gen Intern Med Feb 2008 Boult C et al. J Gerontol Med Sci Mar 2008 Wolff et al. J Geront Med Sci June 2009 Leff B et al. Am J Manag Care August 2009 Boyd C et al. J Gen Intern Med 2010 (in press)

  16. Adopting Guided Care • Care management fees • Commitment by practice staff • A Guided Care nurse • Office, computer, cell phone • Integration of the nurse into the practice • Technical assistance

  17. Technical Assistancewww.MedHomeInfo.org • Guided Care implementation manual • On-line course for Guided Care nurses • On-line course for physicians and practice leaders • Guidance in selecting HIT • Online practice self-assessment (“MHIQ”) • Regional weekend “Learning Collaboratives” • Ongoing electronic “Learning Communities”

  18. Grant Support John A. Hartford Foundation Agency for Healthcare Research and Quality National Institute on Aging Jacob and Valeria Langeloth Foundation

More Related