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Dutch Visitors Get a Guided Care Primer



Excessive health care spending and fragmented medical care are not unique to the U.S.

Exploring solutions to these issues is what brought a group of 26 Dutch visitors in the health care field to the Bloomberg School  for a crash course in Guided Care. The comprehensive, coordinated care model for patients with multiple chronic conditions was developed by Chad Boult and colleagues at the School’s Roger C. Lipitz Center for Integrated Health Care.

At a presentation to the group on June 6, Boult ticked off a long list of weaknesses in the U.S. health care system that Guided Care was designed to address, especially in the care of elderly patients: managing multiple doctors and medications, no family support , too many emergency room admissions and 15-minute doctor visits.

When Boult asked the group if the problems sounded familiar, they nodded and laughed. One participant said that appointments with primary care doctors in the Netherlands last approximately eight minutes.  

“You’re very tuned into the issues,” Boult told the group. “I think I can learn at least as much from you as you can from me.”

The Guided Care model aims to knit together the many threads involved in the care of the chronically ill to reduce health care costs and improve patients’ quality of life. Boult, MD, MPH, MBA, estimates that the approach could save Medicare up to $15 billion per year while providing better care.

“When you’re old in the U.S. and have multiple problems, your health care tends to dominate your life,” said Boult, a professor in the School’s Department of Health Policy and Management. “No one is very happy with the U.S. system—doctors, patients or families.”

He said that 25 percent of all seniors in the U.S. have four or more chronic conditions and account for 80 percent of the Medicare program’s health care spending.

According to the Dutch visitors, the Netherlands is grappling with similar problems in the care of the chronically ill and exploring different ways to address this complex challenge. The participants—including primary care doctors, a lobbyist, a psychologist, health insurance experts, nurses and  researchers—wanted to learn about the Guided Care model,  educating nurses, improving communication among doctors, technical assistance, and the technology required to implement the model.

The Guided Care model was tested at eight primary care sites in the Baltimore-Washington, D.C. area in a 32-month randomized controlled trial involving over 900 patients, 300 caregivers and 49 primary care physicians. Results after twenty months indicate that Guided Care improves the quality of patient care, improves caregivers’ perceptions of quality, improves physician satisfaction in treating the chronically ill, improves nurses’ job satisfaction, and may reduce the use and cost of expensive services in well managed systems."

During its visit, the Dutch group also attended presentations on Guided Care's online nursing course, heard an insurerer's perspective on Guided care and took part in the webinar "Guided Care Health Information Technology."

“I think this model is really promising,” says Annet Wind, MD, PhD, a primary care doctor with a specialty in elder care and a teacher at Leiden University Medical Centre. “The whole
Guided Care centerpiece on the nurse is very interesting.“

Jan Oomes, MSc, managing director of a primary health care organization in Utrecht, had a generally positive response to the model, as well as some concerns.

“I think the problem is to implement it on a broad scale and to financially align all the stakeholders in the process,” he said. — Jackie Powder.

For more information about Guided Care, please visit