Annals Journal Club: Guided Care

doi:10.1370/afm.1148

The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.¹

HOW IT WORKS

In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on “TRACK Comments: Submit a response.”) You can find discussion questions and more information online at: http://www.AnnFamMed.org/AJC/.

CURRENT SELECTION

Article for Discussion

Marsteller JA, Hsu YJ, Reider L, et al. Physician satisfaction with chronic care processes: a cluster-randomized trial of Guided Care. Ann Fam Med. 2010;8(4):308–315.OpenUrl Abstract/FREE Full Text

Discussion Tips

This article provides an opportunity to consider some of the effects and possibilities of an emerging collaborative model of care for complex patients.

Discussion Questions

What question(s) are addressed by this article?
Why is this study needed beyond previous research on this topic?
How strong is the study design for answering the question?
To what degree can the findings be accounted for by:
1. How physicians and their patients were selected, excluded, or lost to follow-up?
2. How the main variables were measured?
3. Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a third factor)?
4. Chance?
Does the analysis accounting for the clustered nature of the data (patients nested within physician) increase your confidence in the findings?*
What are the main study findings?
How comparable is the study sample to similar patients in your practice? What is your judgment about the transportability of the findings?
How might this study change your practice?
How does the concept of Guided Care fit with emerging models of the patient-centered medical home (http://www.pcpcc.net)?
Would the availability of Guided Care (www.guidedcare.org) make you more interested in managing complex older patients in your practice?
If Guided Care proves to be a robust model of care, what further work would need to be done to make it a sustainable part of health care in your country?
What important researchable questions remain?

Footnotes

↵* Hint: The answer is yes. See: Zyzanski SJ, Flocke SA, Dickinson LM. On the nature and analysis of clustered data. Ann Fam Med. 2004;2(3):199–200. http://www.annfammed.org/cgi/content/full/2/3/199.OpenUrl FREE Full Text

REFERENCES

↵
Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It’s time to get RADICAL. Ann Fam Med. 2006;4(3):196–197. http://annfammed.org/cgi/content/full/4/3/196.
OpenUrl FREE Full Text