Effectiveness of a group outpatient visit model for chronically ill older health maintenance organization members: a 2-year randomized trial of the cooperative health care clinic.
OBJECTIVE
To compare the effectiveness of Cooperative Health Care Clinic ((CHCC) group outpatient model for chronically ill, older health maintenance organization (HMO) patients) with usual care.


METHODS
Two-year, randomized, controlled trial conducted with recruitment from February 1995 through July of 1996.


METHODS
Nonprofit group model HMO.


METHODS
Two hundred ninety-four adults (145 intervention and 149 usual care), aged 60 and older (mean age 74.1) with 11 or more outpatient visits in the prior 18 months, one or more self-reported chronic conditions, and expressed interest in participating in a group clinic.


METHODS
Monthly group meetings held by patients' primary care physicians.


METHODS
Differences in clinic visits, inpatient admissions, emergency room visits, hospital outpatient services, professional services, home health, and skilled nursing facility admissions; measures of patient satisfaction, quality of life, self-efficacy, and activities of daily living (ADLs).


RESULTS
Outpatient, pharmacy services, home health, and skilled nursing facility use did not differ between groups, but CHCC patients had fewer hospital admissions (P=.012), emergency visits (P=.008), and professional services (P=.005). CHCC patients' costs were $41.80 per member per month less than those of control patients. CHCC patients reported higher satisfaction with their primary care physician (P=.022), better quality of life (P=.002), and greater self-efficacy (P=.03). Health status and ADLs did not differ between groups.


CONCLUSIONS
The CHCC model resulted in fewer hospitalizations and emergency visits, increased patient satisfaction, and self-efficacy, but no effect on outpatient use, health, or functional status.
Scott
John C
JC
Division of Geriatrics, University of Colorado Health Sciences Center, Denver, Colorado, USA.
Conner
Douglas A
DA
Venohr
Ingrid
I
Gade
Glenn
G
McKenzie
Marlene
M
Kramer
Andrew M
AM
Bryant
Lucinda
L
Beck
Arne
A
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy*; D003120:Colorado; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D015577:Geriatric Assessment; D017048:Health Care Costs / Q000706:statistics & numerical data; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D010353:Patient Education as Topic / Q000458:organization & administration; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration; D015397:Program Evaluation; D011788:Quality of Life; D020377:Self Efficacy; D012657:Self-Help Groups / Q000458:organization & administration*