Article Figures & Data
Tables
- Table 1.
Summary of Research on Group Visits, Including Study Sample, Type of Group Visit, Strength of Evidence, and Outcomes
Primary Author Year Sample N Visit Type Length/ Frequency of Visit Rate of Attendance RCT? Intent-to-Treat Analysis? ≥80% Follow-up? Significantly Favorable Outcomes Nonsignificant Outcomes Beck 1997 Chronically ill, high-utilizing older adults 321 CHCC; individual visits as needed 2 hours, once a month for 1 year Average number of sessions attended: 6.62 (55% of sessions) Yes Yes Nearly (78.5%) Emergency room visits
Subspecialist visits
Repeat hospital admissions
Same-day internal medicine visits
Imaging tests
Influenza and pneumonia vaccinations
Aggregate cost savings ($14.79 per participant per month)
Patient satisfaction
Number of laboratory tests prescribed
Prescription medications
Admissions to SNFs
Receiving VNS
Length of hospital stays
Median hospital charges
Mobility
ADLs
IADLs
Depression (Short Geriatric Depression Scale)
Blumenfeld 2003 Headache 497 Headache Management Program; 2 comprehensive individual visits with NP. 2 hours; one session (offered weekly), led by neurologist followed by 2 self-management consultations with an NP 2 and 8 weeks later N/A (one session) No N/A N/A Decreased primary care visits
Decreased emergency visits
Decreased CT scans
Quality of life (migraine-specific)
Physical function (SF-36)
Symptom improvement
Medication use (injected and oral narcotics)
Increased neurology visits
Nonsignificant increase in non-headache visits
Nonsignificant increase in oral triptan use
Clancy 2003* Type II diabetes 120 CHCC; individual visits every session 2 hours; once per month for 6 months Not described Yes Not reported Yes (data obtained via chart abstraction) Improvement in ADA standards of care
Improved sense of trust in physician
HbA1c
Lipid profiles
Perceptions of better coordination of care, community orientation, and culturally competent care (trend towards significance) (Patient Care Assessment Tool)
All other aspects of the Patient Care Assessment Tool
Coleman 1999 Frail older adults at high risk of hospitalization 169 Chronic Care Clinic; individual visits every session One half-day; once every 3 to 4 months over 2 years 53% attended 2 or more sessions; 29% attended none Yes Yes Yes Decreased urinary incontinence at 12-month follow-up
Primary care visits
Emergency visits
Hospitalizations
Mean hospital days
Urinary incontinence at 24-month follow-up
Frequency of falls
Depression (CES-D)
Patient satisfaction
Functional status (SF-36)
Rate of use of high-risk medications
Costs
Dodds 1992 Physicians (quality of care study) 31 ′Group discussions′ individual visits every session 53 minutes; 14 sessions offered N/A (physicians, not patients, were studied) No N/A N/A Recommended content covered in the following areas: safety, nutrition, behavior and development, and sleep
Recommended content regarding family and parenting issues
Maizels 2003 Headache 264 Headache Clinic; individual visits every session One session; 25 separate sessions offered; length not described N/A (one session) No N/A N/A Increase in triptan costs (nearly all accounted for by for previous non-users of triptans); no statistical analysis
Decrease in triptan costs among previously high utilizers of triptans; no statistical analysis
Decrease in frequency of severe headaches; no statistical analysis
Reduction in total costs; no statistical analysis
Reduction in headache-related total and emergency visits; no statistical analysis
N/A Masley 2001 Coronary artery disease 97 Group Education; no individual medical visits 1.5 hours; 14 sessions over 1 year (weekly during the first month, monthly thereafter) Not described Yes No Yes Increased health behaviors (eating fruits and vegetables, cooking with monounsaturated fat) compared to controls
Reductions in low-density lipoprotein reductions among intervention patients (compared to baseline)
Total per member per month expenses
Total and saturated fat intake
Difference in LDL reduction between groups
Total cholesterol/HDL ratio, triglycerides, and HDL
HbA1c
Total and pharmacy PMPM expenses
Miller 2004 Chronically ill, low-income women (ages 40 to 64) 28 CHCC; individual visits within the group every session 1.5 hours; 6 sessions over a 9-month period 57% attended 3 or more sessions, 32% attended 1 or 2 sessions, and 11% attended only the orientation session; overall 51% attendance rate No N/A Yes Decrease in emergency and urgent care visits
Overall frequency of clinic visits (including emergency, urgent care, primary provider and specialty visits)
Noffsinger 2001 All patients in 4 practices. Avg. 41.8/wk DIGMA 1.5 hours (3 practices); 1 hour (1 practice); 1 session offered weekly The average attendance rate for pre-registered patients was 81%. This was not a cohort. No N/A N/A Increased patient satisfaction
Increased physician satisfaction (qualitative)
N/A Osborn 1981 Mother-infant pairs 78 ′Group visits′ group discussion; individual visits every session 45 group sessions, each followed by individual visit; at least 3 visits during first 6 months of baby’s life Those attending group visits averaged 3.4 visits in first 6 months; controls completed 2.9 visits. 28% of control infants and 10% of group infants did not complete 3 visits No No Yes Increased attendance at prescribed well-child visits
Increased likelihood of stating their child had not been ill
Decreased likelihood of seeking advice between visits
Less time discussing physical aspects of care and more time discussing personal issues in baby’s daily care
Decrease in direct questions and reassurance from baseline, but increased explanations.
Decrease in indirect questions and reassurance compared to controls, but an increase in direct questions
Clinician time spent per infant
Utilization of health care services
Patient satisfaction
Power 1983 Diabetes (type unclear) 203 ′Group visits′ different patients each visit; individual visits as needed 6 sessions; 1 hour each over the course of a year. Patients scheduled for groups according to need. 10 patients did not complete the study (4.9%). Long-term no-show rate for return visits was 10%. Yes No Yes Improved control of mean blood glucose compared to baseline among group patients
Body weight
Insulin use
Power 1992 Obese patients (20 lbs. or more above ideal body weight) 121 ′Group visits′ no individual visit 1-hour classes held weekly, biweekly, and monthly over 5 years. ′Patients stayed long enough to be followed for 5 years.′ No N/A Yes Reduction in obesity (significance not reported; 20%)
Reduction in blood pressure (significance not reported; 20%)
Reduction in cholesterol (significance not reported; 80%)
N/A Sadur 1999 Type I and II diabetes 185 Cluster visits led by diabetes nurse educator; rare individual medical visits 2 hours; once per month for 6 months. Between meetings, the nurse educator reviewed diabetes management by telephone according to patient needs. Not described Yes Not reported Yes Decrease in HbA1c levels compared to controls at six months
Increase in medication use (insulin, sulfonylureas, metformin) compared to controls
Increased nutritionist consultation
Increased frequency of blood glucose monitoring)
Decrease in average home blood glucose level over the past month
Increase in self-efficacy compared with the control group (balancing one’s diet to maintain blood glucose, the ability to recognize and treat blood glucose, maintaining blood glucose when ill)
Satisfaction with diabetes care compared to controls
Lowered frequency of hospitalizations compared to controls
Decrease in non-physician visits compared to controls
Decrease in physician visits (although this was almost significant)
Urgent care clinic visits
Emergency visits
Optometry and ophthalmology visits
Difference between control and intervention HbA1c at 12 months
Proportion of subjects monitoring blood glucose at home
Self-assessed ease of maintaining an acceptable blood glucose level
Frequency of foot self-exam
Exercise
Self-efficacy (follow a low-fat diet, exercise regularly, monitor blood glucose regularly, communicating with physicians, expressing feelings about diabetes to family and friends)
Satisfaction with general medical care
Scott 2004 Chronically ill, high-utilizing older adults 294 CHCC; individual visits as needed 90 minutes; once per month for 24 months Average number of sessions attended: 10.6 (40.8% of sessions); 25.5% attended 2 or fewer sessions Yes Yes Nearly (78%) Decreased inpatient admissions
Decreased emergency visits
Decreased professional services
Decreased ED costs
Increased quality of life compared to controls (general)
Increased self-efficacy regarding communicating with physicians compared with compared to controls
Increased patient satisfaction with primary care physician, physician unhurriedness, time spent with physician, overall quality of care, learning medication management from pharmacists, and learning self-management from nurses compared to controls
Outpatient hospital visits
Observation unit admissions
Pharmacy services
Home health care
SNF use
Health status
ADLs
Hospital, professional, and health-plan termination costs (trend towards significance)
Pharmacy costs, total costs
Self-efficacy regarding disease management, doing chores, participating in social/recreational activities, and controlling/ managing depression
Trento 2002 Type II diabetes 112 ′Group Care′ shared similarities with both Chronic Care Clinics and DIGMAs; individual visits as needed 69 minutes, including elective individual care; approximately once every 3 months for 4 years Unclear, but implied to be high. Yes Yes Yes Stable serum nitrogen compared to control group, in which it increased
Increases in health behaviors (compared to controls, in whom they decreased)
Less progression of retinopathy
Total patient costs: $159.11 for group patients, $95.25 for controls (significance not reported)
For other outcomes, see Trento 2004
Relative CVD risk
Systolic/disatolic blood pressure
Microalbuminuria
For other outcomes, see Trento 2004
Trento 2004 Type II diabetes 112 ′Group Care′ shared similarities with both Chronic Care Clinics and DIGMAs; individual visits as needed 69 minutes, including elective individual care; approximately once every 3 months for 5 years (continuation of prior study; slightly different outcomes examined) Not described Yes Yes No Increase in problem-solving ability from baseline (controls worsened)
Stable HbA1c compared to controls (in which it increased)
Increased quality of life (diabetes-specific)
Increased diabetes knowledge (compared to controls, in whom it decreased)
Decrease in hypoglycemic agents (compared to controls, in whom they increased)
BMI
Body weight
HDL
Use of antihypertensive and lipid-lowering medication
Triglyceride
Creatinine
Fasting blood glucose
Wagner 2001 Type II diabetes 707 Chronic Care Clinic; individual visits every session One half-day; once every 3 to 6 months over 2 years Majority attended 3 or more sessions (up to 6); 35% attended none Yes Yes Yes Increased quality of care (number of recommended preventive procedures, increased participation in patient education)
Fewer bed disability days
Lowered frequency of specialty visits
Lowered frequency of emergency room visits
Improved general health status (SF-36 subscale)
Primary care visits (trend towards significance)
Hospitalization frequency
Rates of foot exams, retinal exams, and medication reviews
Patient satisfaction (diabetes-specific and overall)
Physical function, physical role function (two SF-36 subscales)
Depression (CES-D)
Restricted-activity days
Total health care costs
HbA1c and cholesterol
* Clancy et al. published three articles that month using the same study data.
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