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

Beck, Arne; Scott, John C.; Williams, Patrick A.; Robertson, Barbara; Jackson, Deborrah; Gade, Glenn; Cowan, Pamela

doi:10.1111/j.1532-5415.1997.tb03085.x

Cited by 255 publications

(204 citation statements)

References 4 publications

Supporting

Mentioning

198

Contrasting

Unclassified

Order By: Relevance

“…A related model, the cooperative health care clinic (31), has been shown to improve outcomes in diabetic patients (32). The diabetes cooperative health care clinics differed from the chronic care clinics in that they were led by a diabetes nurse educator, they did not involve the primary care team, and they conducted most of their assessment, education, and other activities in a group setting (32).…”

Section: Discussionmentioning

confidence: 99%

Chronic Care Clinics for Diabetes in Primary Care

et al. 2001

View full text Add to dashboard Cite

OBJECTIVE -To evaluate the impact of primary care group visits (chronic care clinics) on the process and outcome of care for diabetic patients.RESEARCH DESIGN AND METHODS -We evaluated the intervention in primary care practices randomized to intervention and control groups in a large-staff model health maintenance organization (HMO). Patients included diabetic patients Ն30 years of age in each participating primary care practice, selected at random from an automated diabetes registry. Primary care practices were randomized within clinics to either a chronic care clinic (intervention) group or a usual care (control) group. The intervention group conducted periodic one-half day chronic care clinics for groups of ϳ8 diabetic patients in their respective doctor's practice. Chronic care clinics consisted of standardized assessments; visits with the primary care physician, nurse, and clinical pharmacist; and a group education/peer support meeting. We collected self-report questionnaires from patients and data from administrative systems. The questionnaires were mailed, and telephoned interviews were conducted for nonrespondents, at baseline and at 12 and 24 months; we queried the process of care received, the satisfaction with care, and the health status of each patient. Serum cholesterol and HbA 1c levels and health care use and cost data was collected from HMO administrative systems.RESULTS -In an intention-to-treat analysis at 24 months, the intervention group had received significantly more recommended preventive procedures and helpful patient education. Of five primary health status indicators examined, two (SF-36 general health and bed disability days) were significantly better in the intervention group. Compared with control patients, intervention patients had slightly more primary care visits, but significantly fewer specialty and emergency room visits. Among intervention participants, we found consistently positive associations between the number of chronic care clinics attended and a number of outcomes, including patient satisfaction and HbA 1c levels.CONCLUSIONS -Periodic primary care sessions organized to meet the complex needs of diabetic patients improved the process of diabetes care and were associated with better outcomes. Diabetes Care 25:695-700, 2001

show abstract

Section: Discussionmentioning

confidence: 99%

Chronic Care Clinics for Diabetes in Primary Care

et al. 2001

View full text Add to dashboard Cite

show abstract

“…These results are not surprising in light of findings from a number of large managed care organizations using group appointments for chronic disease management. They have found not only lower costs [27][28][29] and reduced utilization [27,[29][30][31] but also improved patient satisfaction [27,[31][32][33], self-efficacy [29,31], health status, [28,31,[33][34][35][36][37][38], compliance [39], and quality of life (QOL) [29]. For example, in a randomized trial comparing group versus individual outpatient visits for patients with a variety of chronic illnesses, patients treated in group appointments had fewer emergency room and subspecialty visits, fewer hospital admissions, greater patient and provider satisfaction, and lower overall costs [27].…”

Section: In This Nonrandomized Retrospective Chart Review Of New Hearmentioning

confidence: 99%

“…Although no data definitively support the precise mechanisms of group visits that produce better outcomes, several mediators have been postulated, including presence of family members [42][43][44], more attention from providers [45][46][47], group interactions that foster camaraderie [19,38,[42][43][44][47][48] and reduce social isolation [19,27,42,49], and shared insights and experiences [27,[43][44]47,49]. In addition, a more relaxed pace and repetition [34,[38][39]49] and more opportunities for questions [19,39,47] may help patients retain information.…”

Section: In This Nonrandomized Retrospective Chart Review Of New Hearmentioning

confidence: 99%

Effectiveness of group versus individual hearing aid visits

Collins

Souza

O'Neill

et al. 2007

JRRD

View full text Add to dashboard Cite

Abstract-Demand for hearing aid services in the VeteransHealth Administration increased over 300% from 1996 to 2005, challenging the delivery of timely, high-quality care. Using group visits may help meet these needs, but whether this approach would still provide high-quality rehabilitation is unclear. This study determined whether group visits worsen hearing aid outcomes. It included a retrospective observational cohort in veterans seeking hearing aids at the Department of Veterans Affairs Puget Sound Health Care System from September 2004 to March 2005, when the clinic was using both individual and group visits. Medical records were reviewed for all new hearing aid patients seen during this period. Hearing-related outcome questionnaires were compared between patients seen for individual versus group fitting and/or follow-up visits. Results revealed that hearing thresholds were similar between patients seen individually and in groups. Of 74 patients who returned self-administered questionnaires after the follow-up, those who received both fitting and follow-up in a group format reported similar hearing handicap and better hearing-related function, satisfaction, and adherence than patients who received individual visits. Group visits did not appear to yield worse outcomes in this nonrandomized retrospective chart review. Definitive statements must await randomized comparisons.

show abstract

“…For example, some practices now have nonphysician staff help patients complete a behavioral and depression screen before being seen by the physician (33). Others have shifted their care for diabetic patients from one-on-one to group medical visits (34,35). Still others have adopted automated within-practice systems to track, monitor, and record self-management behaviors and care in ways that free up time for additional patient screening and intervention (36).…”

Section: Incorporating Principles Of Behavior Change Into All Aspectsmentioning

confidence: 99%

A Call for More Effectively Integrating Behavioral and Social Science Principles Into Comprehensive Diabetes Care

Fisher

Glasgow

2007

Diabetes Care

View full text Add to dashboard Cite

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

Abstract: 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.

Cited by 255 publications

References 4 publications

Chronic Care Clinics for Diabetes in Primary Care

Chronic Care Clinics for Diabetes in Primary Care

Effectiveness of group versus individual hearing aid visits

A Call for More Effectively Integrating Behavioral and Social Science Principles Into Comprehensive Diabetes Care

Contact Info

Product

Resources

About