Guided Care: Integrating High Tech and High Touch

超出所提供的空间。美国老年慢性病患者的医疗保健往往是支离破碎的，而且以医疗服务提供者为中心。作为回应，约翰霍普金斯大学（Johns Hopkins University）的一组研究人员将七项慢性病护理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信息技术的支持下，“指导性护理”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。在初级保健实践中，一名受过专门训练的指导护理护士与两名初级保健医生合作，为40至60名高风险患者提供7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、教育和支持无薪照顾者以及获取社区资源。我们提出的多地点研究将衡量指导性护理对高风险老年人、他们的无偿护理者和初级保健医生的护理质量和结果的影响。由6家诊所的22名医生组成的小组将进行筛选，以确定1350名高风险老年患者。在850名患者给予知情同意和基线访谈后，每个诊所的1-3名医生将随机分组，为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组都将GCN纳入其实践；被分配到对照组的医生群将继续提供没有GCNs的“常规护理”。面谈和查询行政数据库将在基线和12个月和24个月的随访间隔提供评价数据。主要结局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总结量表）。次要结局变量包括：受试者的护理质量；无薪照护者的负担、成本、健康和满意度；以及初级保健医生对慢性护理的满意度。意向治疗分析在检测两组生理和心理健康之间有临床意义的差异方面有85%的效力（范围70-97%）。如果试验结果有利，该研究旨在促进指导护理的迅速传播。代表美国消费者、提供者、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通知研究的操作和评估，并将促进随后在美国卫生保健中传播指导护理工具和技术。网站性能 ======================================== 节结束 ===========================================

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===========================================