Annals Journal Club: Guided Care
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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/](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.[Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiOC80LzMwOCI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80L2lpaS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

### 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](http://www.pcpcc.net))?

*   Would the availability of Guided Care ([www.guidedcare.org](http://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](http://www.annfammed.org/cgi/content/full/2/3/199).[FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiMi8zLzE5OSI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80L2lpaS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)

*   © 2010 Annals of Family Medicine, Inc.

## REFERENCES

1.  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](http://annfammed.org/cgi/content/full/4/3/196).
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNC8zLzE5NiI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vOC80L2lpaS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)