title: Reducing emergency visits in older adults with chronic illness. A randomized, controlled trial of group visits.
abstract: BACKGROUND
  Emergency department utilization by chronically ill older adults may be an important sentinel event signifying a breakdown in care coordination. A primary care group visit (i.e., several patients meeting together with the provider at the same time) may reduce fragmentation of care and subsequent emergency department utilization.
  
  
  OBJECTIVE
  To determine whether primary care group visits reduce emergency department utilization in chronically ill older adults.
  
  
  METHODS
  Randomized trial conducted over a 2-year period.
  
  
  METHODS
  Group-model HMO in Denver, Colorado.
  
  
  METHODS
  295 older adults (> or = 60 years of age) with frequent utilization of outpatient services and one or more chronic illnesses.
  
  
  METHODS
  Monthly group visits (generally 8 to 12 patients) with a primary care physician, nurse, and pharmacist held in 19 physician practices. Visits emphasized self-management of chronic illness, peer support, and regular contact with the primary care team.
  
  
  METHODS
  Emergency department visits, hospitalizations, and primary care visits.
  
  
  RESULTS
  On average, patients in the intervention group attended 10.6 group visits during the 2-year study period. These patients averaged fewer emergency department visits (0.65 vs. 1.08 visits; P = 0.005) and were less likely to have any emergency department visits (34.9% vs. 52.4%; P = 0.003) than controls. These differences remained statistically significant after controlling for demographic factors, comorbid conditions, functional status, and prior utilization. Adjusted mean difference in visits was -0.42 visits (95% CI, -0.13 to -0.72), and adjusted RR for any emergency department visit was 0.64 (CI, 0.44 to 0.86).
  
  
  CONCLUSIONS
  Monthly group visits reduce emergency department utilization for chronically ill older adults.
authors.affiliation: Center on Aging Research Section, Division of Geriatric Medicine, University of Colorado, Denver, Colo., USA. Eric.Coleman@uchsc.edu
authors.forename: E A
authors.initials: EA
authors.lastname: Coleman
authors.forename: T B
authors.initials: TB
authors.lastname: Eilertsen
authors.forename: A M
authors.initials: AM
authors.lastname: Kramer
authors.forename: D J
authors.initials: DJ
authors.lastname: Magid
authors.forename: A
authors.initials: A
authors.lastname: Beck
authors.forename: D
authors.initials: D
authors.lastname: Conner
mesh_terms: D000368:Aged; D002908:Chronic Disease; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006126:Group Processes; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006302:Health Services Research; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric; D014600:Utilization Review