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: 7653666
• 负责人: CHARLES E BOULT
• 金额: $ 30.38万
• 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/7653666
• 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，以提供者为中心。作为回应，A 约翰霍普金斯大学的一个研究小组已经翻译了七个成功的科学原理， 将慢性病护理的创新整合为一个以患者为中心的服务体系。在循证指南的支持下， “引导式护理”是一种先进的信息技术，目前正在老年人初级护理方面进行为期12个月的试点测试 有复杂需求的患者。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名高危患者提供七项服务： 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，教育和支持无偿护理人员， 社区资源。 我们提出的多中心研究将衡量引导式护理对以下患者护理质量和结果的影响： 高风险老年人、他们的无酬照顾者和他们的初级保健医生。六个国家的22名医生组成的小组 将对1350名高危老年患者进行筛查。在850人提供知情同意书和基线后 访谈中，每个诊所的1-3名医生将被随机分组，提供指导性护理或常规护理。 照顾他们同意的病人。分配给引导式护理组的每个医师群集将在 分配给对照组的医生群将继续提供没有GCN的“常规护理”。 访谈和查询行政数据库将提供基线以及12岁和24岁时的评价数据。 月随访间隔。主要结果变量是参与者的身体和心理健康（SF-36身体健康 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; 照顾者的负担，成本，健康和满意度;和初级保健医生对慢性病护理的满意度。意图- 治疗间分析将有85%的把握度（范围70-97%）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，本研究旨在促进指导性护理的迅速传播。 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 政策制定者将为研究的运作和评估提供信息，并将促进随后的传播 引导式护理工具和技术在整个美国的医疗保健。

项目成果

Who participates in chronic disease self-management (CDSM) programs? Differences between participants and nonparticipants in a population of multimorbid older adults.

• DOI: 10.1097/mlr.0b013e318268abe7
• 发表时间: 2012-12
• 期刊: Medical care
• 影响因子: 3
• 作者: Dattalo M;Giovannetti ER;Scharfstein D;Boult C;Wegener S;Wolff JL;Leff B;Frick KD;Reider L;Frey K;Noronha G;Boyd C
• 通讯作者: Boyd C

Effects of guided care on family caregivers.

指导护理对家庭护理人员的影响。

• DOI: 10.1093/geront/gnp124
• 发表时间: 2010
• 期刊: The Gerontologist
• 作者: Wolff,JenniferL;Giovannetti,ErinR;Boyd,CynthiaM;Reider,Lisa;Palmer,Sara;Scharfstein,Daniel;Marsteller,Jill;Wegener,StephenT;Frey,Katherine;Leff,Bruce;Frick,KevinD;Boult,Chad
• 通讯作者: Boult,Chad

Do older patients and their family caregivers agree about the quality of chronic illness care?

老年患者及其家庭护理人员是否同意慢性病护理的质量？

• DOI: 10.1093/intqhc/mzt052
• 发表时间: 2013
• 期刊: International journal for quality in health care : journal of the International Society for Quality in Health Care
• 作者: Giovannetti,ErinR;Reider,Lisa;Wolff,JenniferL;Frick,KevinD;Boult,Chad;Steinwachs,Don;Boyd,CynthiaM
• 通讯作者: Boyd,CynthiaM

Guided care and the cost of complex healthcare: a preliminary report.

指导护理和复杂医疗保健的成本：初步报告。

• 发表时间: 2009
• 期刊: The American journal of managed care
• 作者: Leff,Bruce;Reider,Lisa;Frick,KevinD;Scharfstein,DanielO;Boyd,CynthiaM;Frey,Katherine;Karm,Lya;Boult,Chad
• 通讯作者: Boult,Chad