Improving Chronic Care: The “Guided Care” Model


 
By Chad Boult, MD, MPH, MBA; Lya Karm, MD; Carol Groves, RN, MPA

Winter 2008 - Volume 12 Number 1

https://doi.org/10.7812/TPP/07-014

Introduction: What’s the Problem?


Everyone is working hard, but the quality of chronic care is still mediocre. Donald Berwick, MD, says “every system is designed perfectly to achieve the results that it achieves.”1 The problem is the growing mismatch between the chronic care needs of the population and the acute care orientation of the health care system. Sixty-five million older people with multiple chronic conditions are trying to get health care from a system that is designed to treat acute illnesses and injuries. It’s as though we are trying to put a square peg in a round hole. We will continue to get the poor results we are now getting until we redesign the system.
Guided Care is a new model for “chronic care” that is now being tested by Kaiser Permanente (KP) in the Baltimore-Washington, DC area. Guided Care is primary health care infused with the operative principles of recent innovations to ensure optimal outcomes for patients with chronic conditions and complex health care needs. A registered nurse who has completed a supplemental educational curriculum works in a practice with several primary care physicians, conducting eight clinical processes for 50-60 multimorbid patients.

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