Program History & Results

The Guided Care model was developed by a team of researchers at Johns Hopkins University, to respond to the growing challenge of caring for a rapidly aging America.   

The team conducted a one-year pilot study of Guided Care. Results suggested that the model improved the quality and efficiency of care, and was feasible and acceptable to physician, patients, and family caregivers. Patients who received Guided Care rated their quality of care significantly higher than patients who received usual care. [Boyd CM et al. JGIM 2008.]  In addition, the average insurance costs for Guided Care patients were 25% lower over a six month period. [Sylvia ML et al. Dis Manag 2008.]

The team undertook a 32-month cluster-randomized controlled trial at eight urban and suburban community primary care practices in the Baltimore-Washington, DC area. This study assessed the effects of Guided Care on the quality, efficiency and clinical outcomes of health care for chronically ill older patients and their informal caregivers.  904 patients and 308 family caregivers participated.  Results indicate that Guided Care: 

  • Improves the quality of patient care. After 18 months, Guided Care patients were more than twice as likely as usual care patients to rate the quality of their care highly. [Boyd CM et al.,  J Gen Intern Med 2010;25(3):235-42.]  At the conclusion of the study, patients were 66 percent more likely to rate their access to telephone advice as excellent or very good. Boult C et al. JGIM 2013
  • Improves family caregivers' perception of quality. Caregivers of Guided Care patients reported the quality of chronic illness care received by their loved one to be significantly higher than usual care caregivers. Those employed in addition to their caregiving role also reported increased work productivity, and low absenteeism. [Wolff JL et al.  Gerontologist 2010;50(4):459-70.]
  • Improves physicians' satisfaction with chronic care. Compared to physicians in the control group, physicians who provided Guided Care for one year reported higher levels of satisfaction with their patient/family communications and their knowledge of their patients' clinical characteristics. [Marsteller J et al. Ann Fam Med 2010;8(4):308-15.]
  • Produces high job satisfaction among nurses. Guided Care nurses reported a high regard for most aspects of their jobs, consistently expressing high satisfaction with work hour flexibility and the model of care they provide. [Boult C et al. J Gerontol Med Sci 2008;63A(3):321-7.]
  • Increased patient perception of care quality and may reduce the use of expensive services. After 32 months, Guided Care patients experienced, on average, 29% fewer home health care episodes, 13% fewer hospital readmissions, 26% fewer skilled nursing facility days, and 8% fewer skilled nursing facility admissions; the reduction in home health care episodes was statistically significant. (Need link to JGIM – coming 12/15)
  • Reduced the use of services in an Integrated Delivery System.  Guided Care produced even larger reductions in a subset of patients who received their primary care from an integrated delivery system.  Patients experienced, on average, 52% fewer skilled nursing facility days, 47% fewer skilled nursing facility admissions, 49% fewer hospital readmissions, and 17% fewer emergency department visits. [Boult C et al. Arch Intern Med 2011;171(5):460-6.]