Volume 45, Issue 5 p. 543-549

A Randomized Trial of Group Outpatient Visits for Chronically Ill Older HMO Members: The Cooperative Health Care Clinic

Arne Beck PhD

Corresponding Author

Arne Beck PhD

Departments of Research and Development, Colorado Permanente Medical Care Program, Denver, Colorado.

Research and Development, Kaiser Foundation Health Plan of Colorado, 10350 E. Dakota Ave., Denver, CO 80231.Search for more papers by this author
John Scott MD

John Scott MD

Internal Medicine, Colorado Permanente Medical Care Program, Denver, Colorado.

Search for more papers by this author
Patrick Williams MD

Patrick Williams MD

Internal Medicine, Colorado Permanente Medical Care Program, Denver, Colorado.

Search for more papers by this author
Barbara Robertson PhD

Barbara Robertson PhD

Senior Programs, Colorado Permanente Medical Care Program, Denver, Colorado.

Search for more papers by this author
Deborrah Jackson RN

Deborrah Jackson RN

Service Quality Training, Colorado Permanente Medical Care Program, Denver, Colorado.

Search for more papers by this author
Glenn Gade MD

Glenn Gade MD

Internal Medicine, Colorado Permanente Medical Care Program, Denver, Colorado.

Search for more papers by this author
Pamela Cowan

Pamela Cowan

Departments of Research and Development, Colorado Permanente Medical Care Program, Denver, Colorado.

Search for more papers by this author
First published: 27 April 2015
Citations: 180

Funded by grants from the Garfield Memorial Fund (#1019076) and the Research and Development Fund of the Kaiser Foundation Health Plan of Colorado

Abstract

OBJECTIVE: To compare the impact of group outpatient visits to traditional “physician-patient dyad” care among older chronically ill HMO members on health services utilization and cost, self-reported health status, and patient and physician satisfaction.

DESIGN: A 1-year randomized trial.

SETTING: A group model HMO in the Denver Metropolitan area.

PARTICIPANTS: Three hundred twenty-one members aged 65 and older, randomized to a group visit intervention (n = 160) or to usual care (n = 161).

INTERVENTION: Patients with high health services utilization and one or more chronic conditions had monthly group visits with their primary care physician and nurse. Visits included health education, prevention measures, opportunities for socialization, mutual support, and for one-to-one consultations with their physician, where necessary.

MEASUREMENTS: Health services utilization and associated cost, health status, and patient and physician satisfaction.

RESULTS: Outcome measures obtained after a 1-year follow-up period showed that group participants had fewer emergency room visits (P = .009), visits to subspecialists (P = .028), and repeat hospital admissions per patient (P = .051). Group participants made more visits (P = .021) and calls (P = .038) to nurses than control group patients and fewer calls to physicians (P = .019). In addition, a greater percentage of group participants received influenza and pneumonia vaccinations (P < .001). Group participants had greater overall satisfaction with care (P = .019), and participating physicians reported higher levels of satisfaction with the groups than with individual care. No differences were observed between groups on self-reported health and functional status. Cost of care per member per month was $14.79 less for the group participants.

CONCLUSIONS: Group visits for chronically ill patients reduce repeat hospital admissions and emergency care use, reduce cost of care, deliver certain preventive services more effectively, and increase patient and physician satisfaction.