Author Affiliations: Division of Geriatric Medicine, Department of Medicine (Drs Leff and Boyd), and Department of Physical Medicine and Rehabilitation (Dr Wegener), Johns Hopkins University School of Medicine, and Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health (Drs Frick, Scharfstein, and Wolff and Mss Reider, Mroz, and Frey), Baltimore, Maryland.
We appreciate the question posed by Suter et al. However, for a health care delivery model to be effective it must link a focused, relevant intervention to its optimally targeted patient population to bring about its intended outcome. Guided care is a multifaceted primary care–based intervention delivered in an ambulatory practice. Though guided care includes home-based assessment, it was not designed to compete with or supplant home health care, nor was its target population home-bound older adults. Reduction of home health care was neither an intended nor expected outcome of guided care.
Leff B, Boyd C, Reider L, et al. Is Reducing Home Health a Step in the Right Direction?—Reply. Arch Intern Med. 2011;171(17):1597–1598. doi:10.1001/archinternmed.2011.431
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