Table 1.

Summary of Research on Group Visits, Including Study Sample, Type of Group Visit, Strength of Evidence, and Outcomes

Primary AuthorYearSampleNVisit TypeLength/ Frequency of VisitRate of AttendanceRCT?Intent-to-Treat Analysis?≥80% Follow-up?Significantly Favorable OutcomesNonsignificant Outcomes
Beck1997Chronically ill, high-utilizing older adults321CHCC; individual visits as needed2 hours, once a month for 1 yearAverage number of sessions attended: 6.62 (55% of sessions)YesYesNearly (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)

Blumenfeld2003Headache497Headache 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 laterN/A (one session)NoN/AN/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

Clancy2003*Type II diabetes120CHCC; individual visits every session2 hours; once per month for 6 monthsNot describedYesNot reportedYes (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

Coleman1999Frail older adults at high risk of hospitalization169Chronic Care Clinic; individual visits every sessionOne half-day; once every 3 to 4 months over 2 years53% attended 2 or more sessions; 29% attended noneYesYesYes
  • 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

Dodds1992Physicians (quality of care study)31′Group discussions′ individual visits every session53 minutes; 14 sessions offeredN/A (physicians, not patients, were studied)NoN/AN/A
  • Recommended content covered in the following areas: safety, nutrition, behavior and development, and sleep

  • Recommended content regarding family and parenting issues

Maizels2003Headache264Headache Clinic; individual visits every sessionOne session; 25 separate sessions offered; length not describedN/A (one session)NoN/AN/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

Masley2001Coronary artery disease97Group Education; no individual medical visits1.5 hours; 14 sessions over 1 year (weekly during the first month, monthly thereafter)Not describedYesNoYes
  • 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

Miller2004Chronically ill, low-income women (ages 40 to 64)28CHCC; individual visits within the group every session1.5 hours; 6 sessions over a 9-month period57% attended 3 or more sessions, 32% attended 1 or 2 sessions, and 11% attended only the orientation session; overall 51% attendance rateNoN/AYes
  • Decrease in emergency and urgent care visits

  • Overall frequency of clinic visits (including emergency, urgent care, primary provider and specialty visits)

Noffsinger2001All patients in 4 practices.Avg. 41.8/wkDIGMA1.5 hours (3 practices); 1 hour (1 practice); 1 session offered weeklyThe average attendance rate for pre-registered patients was 81%. This was not a cohort.NoN/AN/A
  • Increased patient satisfaction

  • Increased physician satisfaction (qualitative)

Osborn1981Mother-infant pairs78′Group visits′ group discussion; individual visits every session45 group sessions, each followed by individual visit; at least 3 visits during first 6 months of baby’s lifeThose 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 visitsNoNoYes
  • 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

Power1983Diabetes (type unclear)203′Group visits′ different patients each visit; individual visits as needed6 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%.YesNoYes
  • Improved control of mean blood glucose compared to baseline among group patients

  • Body weight

  • Insulin use

Power1992Obese patients (20 lbs. or more above ideal body weight)121′Group visits′ no individual visit1-hour classes held weekly, biweekly, and monthly over 5 years.′Patients stayed long enough to be followed for 5 years.′NoN/AYes
  • Reduction in obesity (significance not reported; 20%)

  • Reduction in blood pressure (significance not reported; 20%)

  • Reduction in cholesterol (significance not reported; 80%)

Sadur1999Type I and II diabetes185Cluster visits led by diabetes nurse educator; rare individual medical visits2 hours; once per month for 6 months. Between meetings, the nurse educator reviewed diabetes management by telephone according to patient needs.Not describedYesNot reportedYes
  • 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

Scott2004Chronically ill, high-utilizing older adults294CHCC; individual visits as needed90 minutes; once per month for 24 monthsAverage number of sessions attended: 10.6 (40.8% of sessions); 25.5% attended 2 or fewer sessionsYesYesNearly (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

Trento2002Type II diabetes112′Group Care′ shared similarities with both Chronic Care Clinics and DIGMAs; individual visits as needed69 minutes, including elective individual care; approximately once every 3 months for 4 yearsUnclear, but implied to be high.YesYesYes
  • 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

Trento2004Type II diabetes112′Group Care′ shared similarities with both Chronic Care Clinics and DIGMAs; individual visits as needed69 minutes, including elective individual care; approximately once every 3 months for 5 years (continuation of prior study; slightly different outcomes examined)Not describedYesYesNo
  • 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

Wagner2001Type II diabetes707Chronic Care Clinic; individual visits every sessionOne half-day; once every 3 to 6 months over 2 yearsMajority attended 3 or more sessions (up to 6); 35% attended noneYesYesYes
  • 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.