Older people who receive Guided Care use fewer expensive health services

John A. Hartford FoundationMar 15 2011

A new report shows that older people who receive Guided Care, a new form of primary care, use fewer expensive health services compared to older people who receive regular primary care. Research published in the March 2011 edition of Archives of Internal Medicine found that after 20 months of a randomized controlled trial, Guided Care patients experienced, on average, 30 percent fewer home health care episodes, 21 percent fewer hospital readmissions, 16 percent fewer skilled nursing facility days, and 8 percent fewer skilled nursing facility admissions. Only the reduction in home health care episodes was statistically significant.

According to the study, Guided Care produced even larger reductions in a subset of patients who received their primary care from one well managed health system. Guided Care patients in Kaiser Permanente of the Mid Atlantic States experienced, on average, 52 percent fewer skilled nursing facility days, 47 percent fewer skilled nursing facility admissions, 49 percent fewer hospital readmissions, and 17 percent fewer emergency department visits; the differences for skilled nursing facility days and admissions were statistically significant.

"These data suggest that Guided Care can reduce avoidable health service use and costs in well managed systems," said lead author Chad Boult, MD, MPH, MBA. "Because they are part of a delivery system in which their health professionals already work as a team, Kaiser Permanente and similarly coordinated systems may be better able to achieve cost savings with a comprehensive, team-based care model such as Guided Care," said Boult. "We would like to further explore which elements of the Kaiser-Permanente culture may have helped Guided Care reduce the use of costly health services."

This multi-site, randomized controlled trial of Guided Care involving 49 physicians, 904 older patients and 319 family members recently concluded in 8 locations in the Baltimore-Washington, D.C. area. The three-year study was funded by a private-public partnership of the John A. Hartford Foundation, the Jacob and Valeria Langeloth Foundation, the Agency for Healthcare Research and Quality, and the National Institute on Aging.