A randomized trial of group outpatient visits for chronically ill older HMO members: The cooperative health care clinic

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.