Guided Care: Integrating High Tech and High Touch

引导护理：高科技与高接触的结合

• 批准号: 7251939
• 负责人: CHARLES E BOULT
• 金额: $ 49.82万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-01 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7251939
• 关键词: Guided; Care; Integrating; Tech; Touch

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.

患有慢性病的美国老年人的医疗保健往往是分散的并且以提供者为中心。作为回应，一个 约翰·霍普金斯大学的研究团队翻译了七个成功案例的科学原理 将慢性病护理创新纳入以患者为中心的交付系统。得到循证指南的支持和 采用最先进的信息技术，“引导护理”目前正在进行针对老年人初级护理的为期12个月的试点测试 有复杂需求的患者。一名经过专门培训的引导护理护士（GCN），以初级保健实践为基础， 与两名初级保健医生合作，为 40-60 名高危患者提供七项服务：综合 评估和护理计划，促进慢性病的“最佳实践”，促进自我管理， 鼓励健康的生活方式、协调护理、教育和支持无酬护理人员以及获取 社区资源。 我们建议的多地点研究将衡量引导护理对护理质量和结果的影响 高风险老年人、他们的无薪护理人员以及他们的初级保健医生。小组由 6 名 22 名医生组成 将筛选 1350 名高危老年患者。 850 人给予知情同意和基线后 面谈后，每个诊所将随机分配 1-3 名医生，以提供指导护理或常规护理 照顾他们同意的患者。分配给引导护理组的每个医生集群都将把 GCN 纳入 它的实践；分配给对照组的医生小组将在没有 GCN 的情况下继续提供“常规护理”。 行政数据库的访谈和查询将提供基线以及 12 和 24 时的评估数据 月随访间隔。主要结果变量是参与者的身心健康（SF-36 身体健康） 健康和心理健康总结量表）。次要结果变量包括：参与者的护理质量；未付 照顾者的负担、费用、健康和满意度；以及初级保健医生对慢性病护理的满意度。意图- 治疗分析将有 85% 的功效（范围 70-97%）来检测两者之间有临床意义的差异 群体的身心健康。 如果试验结果良好，该研究旨在促进引导护理的迅速传播。 利益相关者顾问委员会，代表美国消费者、提供商、交付系统、保险公司、监管机构和 政策制定者将为研究的运作和评估提供信息 - 并将促进随后的传播 整个美国医疗保健中的引导护理工具和技术。