Guided Care: Integrating High Tech and High Touch

超出所提供的空间。 患有慢性病的美国老年人的医疗保健往往是分散的，以提供者为中心。作为回应，约翰霍普金斯大学的一个研究小组将慢性病护理中七项成功创新的科学原理转化为一个以患者为中心的交付系统。在循证指南和最先进的信息技术的支持下，“引导式护理”目前正在对有复杂需求的老年初级保健患者进行为期12个月的试点测试。一名受过专门训练的指导护理护士（GCN）在初级保健实践中与两名初级保健医生合作，为40-60名高风险患者提供七项服务：全面评估和护理规划，促进慢性病的“最佳做法”，促进自我管理，鼓励健康的生活方式，协调护理，教育和支持无薪护理人员，以及获得社区资源。 我们提出的多地点研究将衡量指导护理对高风险老年人，他们的无偿照顾者和他们的初级保健医生的护理质量和结果的影响。将对6个诊所的22名医生组成的小组进行筛选，以确定1350名高风险老年患者。在850名医生提供知情同意和基线访谈后，每个诊所的1-3名医生将被随机分组，为他们同意的患者提供指导性护理或常规护理。分配给指导护理组的每个医生集群将在其实践中纳入GCN;分配给对照组的医生集群将在没有GCN的情况下继续提供“常规护理”。 访谈和查询管理数据库将提供基线以及12个月和24个月随访间隔时的评价数据。主要结果变量是参与者的身体和心理健康（SF-36身体健康和心理健康汇总量表）。次要结果变量包括：参与者的护理质量;无偿照顾者的负担，成本，健康和满意度;初级保健医生对慢性病护理的满意度。意向治疗分析将有85%的把握度（范围70-97%）检测两组身体和精神健康之间有临床意义的差异。 如果试验结果良好，本研究旨在促进指导性护理的迅速传播。代表美国消费者、供应商、交付系统、保险公司、监管机构和政策制定者的利益相关者咨询委员会将为研究的操作和评估提供信息，并将促进引导式护理工具和技术在整个美国医疗保健领域的后续传播。性能现场=

EXCEED THE SPACE PROVIDED. Health care for older Americans with chronic conditions is often fragmented and provider-centric. In response, a team of investigators at Johns Hopkins University has translated the scientific principles of seven successful innovations in chronic care into one patient-centered delivery system. Supported by evidence-based guidelines and state-of-the-art information technology, "Guided Care" is now undergoing a 12-month pilot test on older primary care patients with complex needs. A specially trained Guided Care Nurse (GCN), based in a primary care practice, collaborates with two primary care physicians to provide seven services for 40-60 high-risk patients: comprehensive assessment and care planning, prompting "best practices" for chronic conditions, promoting self-management, encouraging healthy life styles, coordinating care, educating and supporting unpaid caregivers, and accessing community resources. The multi-site study we propose will measure the effects of Guided Care on the quality and outcomes of care for high-risk older persons, their unpaid caregivers, and their primary care physicians. The panels of 22 physicians in six practices will be screened to identify 1350 high-risk older patients. After 850 have given informed consent and baseline interviews, clusters of 1-3 physicians at each practice site will be randomized to provide either Guided Care or usual care to their consenting patients. Each physician cluster assigned to the Guided Care group will incorporate a GCN into its practice; the physician clusters assigned to the control group will continue providing "usual care" without GCNs. Interviews and queries of administrative databases will provide evaluative data at baseline and at 12- and 24- month follow-up intervals. The primary outcome variable is the participants' physical and mental health (SF-36 Physical Health and Mental Health Summary Scales). Secondary outcome variables include: participants' quality of care; unpaid caregivers' burden, costs, health, and satisfaction; and primary care physicians' satisfaction with chronic care. Intention- to-treat analyses will have 85% power (range 70-97%) to detect clinically meaningful differences between the two groups' physical and mental health. The study is designed to facilitate the prompt dissemination of Guided Care, if the resultsof the trial are favorable. A Stakeholders' Advisory Board, representing U.S. consumers, providers, delivery systems, insurers, regulators and policy-makers, will inform the operation and evaluation of the study - and it will facilitate the subsequent dissemination of Guided Care tools and technology throughout American health care. PERFORMANCE SITE ========================================Section End===========================================