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.