Leff Bruce, Reider Lisa, Frick Kevin D, Scharfstein Daniel O, Boyd Cynthia M, Frey Katherine, Karm Lya, Boult Chad
School of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA.
Am J Manag Care. 2009 Aug;15(8):555-9.
Guided Care (GC) is a model of proactive, evidence-based comprehensive healthcare provided by physician-nurse teams for people with several chronic health conditions. Our objective was to evaluate the preliminary effects of GC on health service utilization and costs.
Cluster-randomized controlled trial of GC involving 14 primary care teams (49 physicians) and 904 of their chronically ill patients age 65 years or older.
Using insurance claims, we compared the health services used by patients who received GC with the health services used by patients who received usual care during the first 8 months of the study.
After adjustment for baseline characteristics, GC patients experienced, on average, 24% fewer hospital days (95% confidence interval [CI]: 49% fewer, 13% more), 37% fewer skilled nursing facility days (95% CI: 65% fewer, 5% more), 15% fewer emergency department visits (95% CI: 38% fewer, 18% more), and 29% fewer home healthcare episodes (95% CI: 53% fewer, 8% more), as well as 9% more specialist visits (95% CI: 8% fewer, 29% more). Based on current Medicare payment rates and GC costs, these differences in utilization represent an annual net savings of $75,000 (95% CI: -$244,000, $150,900) per nurse, or $1364 per patient.
Initial introduction of GC into primary care practices may be associated with less use of expensive health services and a net savings in healthcare costs among older patients with several chronic health conditions. Final results from the remaining 2 years of this ongoing study will be published in 2011.
引导式护理（GC）是一种由医生-护士团队为患有多种慢性健康问题的人群提供的主动式、循证综合医疗保健模式。我们的目的是评估GC对医疗服务利用和成本的初步影响。
GC的整群随机对照试验，涉及14个初级保健团队（49名医生）及其904名65岁及以上的慢性病患者。
利用保险理赔数据，我们比较了接受GC的患者与在研究的前8个月接受常规护理的患者所使用的医疗服务。
在对基线特征进行调整后，GC组患者平均住院天数减少24%（95%置信区间[CI]：减少49%，增加13%），熟练护理设施使用天数减少37%（95%CI：减少65%，增加5%），急诊就诊次数减少15%（95%CI：减少38%，增加18%），家庭医疗护理次数减少29%（95%CI：减少53%，增加8%），专科就诊次数增加9%（95%CI：减少8%，增加29%）。根据当前医疗保险支付率和GC成本，这些利用差异意味着每名护士每年净节省75,000美元（95%CI：-244,000美元，150,900美元），或每名患者节省1364美元。
将GC初步引入初级保健实践可能与老年慢性病患者减少使用昂贵医疗服务以及医疗保健成本净节省有关。这项正在进行的研究剩余2年的最终结果将于2011年发表。
