Richard Adair, MD; Douglas R. Wholey, PhD; Jon Christianson, PhD; Katie M. White, EdD; Heather Britt, PhD; Suhna Lee, MPA
Acknowledgment: The authors thank Lori Boland, MPH (study concept and design); Kimberly Radel, MHA, Deborah Elumba, RN, Sana Iverson, RN, Allison Shipley, BA, and Tamara J. Winden, MBA (study supervision and data acquisition); Sochenda Nelson, BS (manuscript revision); and Jean Marie Berquist, RN, BSN (development of EHR reporting tools).
Financial Support: By the Robina Foundation.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-3106.
Reproducible Research Statement: Study protocol and statistical code: Available from Kimberly Radel (e-mail, firstname.lastname@example.org). Data set: Not available.
Requests for Single Reprints: Kimberly Radel, MHA, Allina Health, 2925 Chicago Avenue, Minneapolis, MN 55407; e-mail, email@example.com.
Current Author Addresses: Dr. Adair: Medicine Clinic, 2800 Chicago Avenue South, #250, Minneapolis, MN 55407.
Drs. Wholey, Christianson, and White and Ms. Lee: University of Minnesota, Division of Health Policy & Management, Mail Code 8729A, 420 Delaware Street SE, Minneapolis, MN 55455.
Dr. Britt: Allina Health, 2925 Chicago Avenue, Minneapolis, MN 55407.
Author Contributions: Conception and design: R. Adair, D.R. Wholey, J. Christianson, K.M. White, H. Britt.
Analysis and interpretation of the data: R. Adair, D.R. Wholey, J. Christianson, K.M. White, S. Lee.
Drafting of the article: R. Adair, K.M. White, S. Lee.
Critical revision of the article for important intellectual content: R. Adair, D.R. Wholey, J. Christianson, K.M. White, H. Britt, S. Lee.
Final approval of the article: R. Adair, D.R. Wholey, J. Christianson, K.M. White, H. Britt.
Statistical expertise: D.R. Wholey, S. Lee.
Obtaining of funding: R. Adair, H. Britt.
Administrative, technical, or logistic support: R. Adair, J. Christianson, H. Britt, S. Lee.
Collection and assembly of data: R. Adair, S. Lee.
Adair R, Wholey DR, Christianson J, White KM, Britt H, Lee S. Improving Chronic Disease Care by Adding Laypersons to the Primary Care Team: A Parallel Randomized Trial. Ann Intern Med. 2013;159:176-184. doi: 10.7326/0003-4819-159-3-201308060-00007
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Published: Ann Intern Med. 2013;159(3):176-184.
Improving the quality and efficiency of chronic disease care is an important goal.
To test whether patients with chronic disease working with lay “care guides” would achieve more evidence-based goals than those receiving usual care.
Parallel-group randomized trial, stratified by clinic and conducted from July 2010 to April 2012. Patients were assigned in a 2:1 ratio to a care guide or usual care. Patients, providers, and persons assessing outcomes were not blinded to treatment assignment. (ClinicalTrials.gov: NCT01156974)
6 primary care clinics in Minnesota.
Adults with hypertension, diabetes, or heart failure.
2135 patients were given disease-specific information about standard care goals and asked to work toward goals for 1 year, with or without the help of a care guide. Care guides were 12 laypersons who received brief training about these diseases and behavior change.
The primary end point for each patient was change in percentage of goals met 1 year after enrollment.
The percentage of goals met increased in both the care guide and usual care groups (changes from baseline, 10.0% and 3.9%, respectively). Patients with care guides achieved more goals than usual care patients (82.6% vs. 79.1%; odds ratio, 1.31 [95% CI, 1.16 to 1.47]; P < 0.001); reduced unmet goals by 30.1% compared with 12.6% for usual care patients; and improved more than usual care patients in meeting several individual goals, including not using tobacco. Estimated cost was $286 per patient per year.
Providers' usual care may have been influenced by contact with care guides. Last available data in the electronic health record were used to assess end points.
Adding care guides to the primary care team can improve care for some patients with chronic disease at low cost.
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