Physician Satisfaction with Chronic Care Processes: A Cluster-Randomized Trial of Guided Care

• Published in: Annals of family medicine 2010-07, Vol.8 (4), p.308-315
• Main Authors: Marsteller, Jill A., PhD, MPP, Hsu, Yea-Jen, MHA, Reider, Lisa, MHS, Frey, Katherine, MPH, Wolff, Jennifer, PhD, Boyd, Cynthia, MD, Leff, Bruce, MD, Karm, Lya, MD, Scharfstein, Daniel, ScD, Boult, Chad, MD, MPH, MBA
• Format: Article
• Language: English
• Subjects: Age Factors; Aging; Attitude of Health Personnel; Chronic Disease; Cluster Analysis; Data Collection; Female; Humans; Internal Medicine; Job Satisfaction; Linear Models; Male; Middle Aged; Models, Theoretical; Multivariate Analysis; Original Research; Patient Care - methods; Patient Care - psychology; Patient-Centered Care - methods; Patient-Centered Care - organization & administration; Physicians, Primary Care; Practice Patterns, Physicians; Surveys and Questionnaires; Time Factors; United States
• ISSN: 1544-1709; 1544-1717
• DOI: 10.1370/afm.1134

Abstract Purpose Chronically ill older patients with multiple conditions are challenging to care for, and new models of care for this population are needed. This study evaluates the effect of the Guided Care model on primary care physicians' impressions of processes of care for chronically ill older patients. Methods In Guided Care a specially educated registered nurse works at the practice with 2 to 5 primary care physicians, performing 8 clinical activities for 50 to 60 chronically ill older patients. The care model was tested in a cluster-randomized controlled trial between 2006 and 2009. All eligible primary care physicians in 14 pods (teams of physicians and their chronically ill older patients) agreed to participate (n = 49). Pods were randomly assigned to provide either Guided Care or usual care. Physicians were surveyed at baseline and 1 year later. We assessed the effects of Guided Care using responses from 38 physicians who completed both survey questionnaires. We measured physicians' satisfaction with chronic care processes, time spent on chronic care, knowledge of their chronically ill older patients, and care coordination provided by physicians and office staff. Results Compared with the physicians in the control group, those in the Guided Care group rated their satisfaction with patient/family communication and their knowledge of the clinical characteristics of their chronically ill older patients significantly higher (S