Guided Care: Integrating High Tech and High Touch

患有慢性病的美国老年人的医疗保健往往是支离破碎的，而且是以提供者为中心的。作为回应，一个 约翰·霍普金斯大学的一组研究人员翻译了七个成功的科学原理 将慢性护理的创新转化为以患者为中心的交付系统。由循证指导方针和 最先进的信息技术，“指导式护理”目前正在进行为期12个月的老年初级保健试点试验 有复杂需求的病人。受过专门培训的指导护理护士(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：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，教育和支持无偿照顾者，并获得 社区资源。 我们提出的多点研究将衡量指导性护理对护理质量和结果的影响 高危老年人、他们的无偿照顾者和他们的初级保健医生。由6名医生组成的22名专家小组 将对做法进行筛选，以确定1350名高危老年患者。850人之后给予知情同意和基线 访谈，每个执业地点的1-3名医生将被随机分组，以提供指导护理或普通护理 照顾他们同意的病人。分配给指导性护理组的每个医生群组将把GCN合并到 它的做法；被分配到对照组的医生群将在没有GCNS的情况下继续提供“日常护理”。 对行政数据库的约谈和查询将提供基线和12-24年度的评价数据 每隔一个月进行一次随访。主要结果变量是参与者的身心健康(SF-36身体状况 健康和精神健康摘要量表)。次要结果变量包括：参与者的护理质量；无偿 护理者的负担、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- TO-Treat分析将有85%的力量(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。 这项研究旨在促进指导护理的迅速传播，如果试验的结果是有利的。 利益相关者咨询委员会，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，将告知研究的运作和评估--它将促进随后的传播 指导医疗工具和技术在整个美国医疗保健中的应用。

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.