Improving chronic care: the "guided care" model.

Chad Boult, MD, MPH, MBA, (top) is Director, lipitz Center for Integrated Health Care, and Professor in the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University; and a participant on the Advisory Panel of the Case Management Society of America’s National Transitions of Care Coalition to improve the quality of care between health care settings. E-mail: [email protected]. Lya Karm, MD, (left) is an Internist at the West End Medical Center in Washington, DC, and Physician Director of Senior Services for the Kaiser Permanente Mid-Atlantic Region. E-mail: [email protected]. Carol Groves, rN, MPA, (right) is the Director of Senior Services for the Kaiser Permanente Mid-Atlantic States. E-mail: [email protected]. 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.” 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.