Effectiveness of a Group Outpatient Visit Model for Chronically Ill Older Health Maintenance Organization Members: A 2-Year Randomized Trial of the Cooperative Health Care Clinic.
Scott, John C. MD *; Conner, Douglas A. PhD ++; Venohr, Ingrid RN, PhD [S]; Gade, Glenn MD [//]; McKenzie, Marlene RN [S]; Kramer, Andrew M. MD +; Bryant, Lucinda PhD +; Beck, Arne PhD ++
Journal of the American Geriatrics Society.
52(9):1463-1470, September 2004.
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OBJECTIVES: To compare the effectiveness of Cooperative Health Care Clinic ((CHCC) group outpatient model for chronically ill, older health maintenance organization (HMO) patients) with usual care.
DESIGN: Two-year, randomized, controlled trial conducted with recruitment from February 1995 through July of 1996.
SETTING: Nonprofit group model HMO.
PARTICIPANTS: Two hundred ninety-four adults (145 intervention and 149 usual care), aged 60 and older (mean age 74.1) with 11 or more outpatient visits in the prior 18 months, one or more self-reported chronic conditions, and expressed interest in participating in a group clinic.
INTERVENTION: Monthly group meetings held by patients' primary care physicians.
MEASUREMENT: Differences in clinic visits, inpatient admissions, emergency room visits, hospital outpatient services, professional services, home health, and skilled nursing facility admissions; measures of patient satisfaction, quality of life, self-efficacy, and activities of daily living (ADLs).
RESULTS: Outpatient, pharmacy services, home health, and skilled nursing facility use did not differ between groups, but CHCC patients had fewer hospital admissions (P = .012), emergency visits (P = .008), and professional services (P = .005). CHCC patients' costs were $41.80 per member per month less than those of control patients. CHCC patients reported higher satisfaction with their primary care physician (P = .022), better quality of life (P = .002), and greater self-efficacy (P = .03). Health status and ADLs did not differ between groups.
CONCLUSION: The CHCC model resulted in fewer hospitalizations and emergency visits, increased patient satisfaction, and self-efficacy, but no effect on outpatient use, health, or functional status.
(C) 2004 by the American Geriatrics Society