One of the pillars of health care system reform efforts in the United States is better management of serious chronic illness. This will, we believe, improve quality and decrease costs by preventing avoidable complications, emergency department visits, and hospitalizations.
It is therefore frustrating to practicing health care professionals, researchers, and policymakers that carefully designed studies of programs implementing evidence-based best practices for patients with serious multiple chronic conditions have shown only limited success. For example, in this issue of the Archives, Boult et al present the results of a multicenter randomized study examining the effect of guided care on the care of patients older than 65 years. The intervention, based on best practices, included comprehensive geriatric assessment, evidence-based planning, case management, transitional care, self-management, and caregiver support. The care was provided by interdisciplinary teams, including physicians and nurses. However, despite the comprehensiveness of the intervention, the effects on service use were minimal.