Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL.
University of Michigan Medical School, Ann Arbor, MI.
Med Care. 2023 Dec 1;61(12):866-871. doi: 10.1097/MLR.0000000000001937. Epub 2023 Oct 11.
We evaluated the economic impact of group visits (GVs) in adults with uncontrolled diabetes in community health centers (CHCs) in the United States.
In this prospective controlled trial, we implemented 6 monthly GV sessions in 5 CHCs and compared intervention patients (n=49) to control patients (n=72) receiving usual care within the same CHCs. We conducted patient chart reviews to obtain health care utilization data for the prior 6 months at baseline, 6 months (during the GV implementation), and 12 months (after the implementation). We also collected monthly logs of CHC expenses and staff time spent on activities related to GVs. Per-patient total costs included CHCs' expenses and costs associated with staff time and patients' health care use. For group comparison, we used the Wilcoxon rank-sum test and the bootstrapping method that was to bootstrap generalized estimating equation models.
The GV group had fewer 6-month hospitalizations (mean: GV: 0.06 vs. control: 0.24, rate: 6.1% vs. 19.4%) ( P ≤ 0.04) and similar emergency department visits at 12 months than the control group. Implementing GV incurred $1770 per-patient. The intervention cost $1597 more than the control at 6 months ($3021 vs. $1424) but saved $1855 at 12 months ($857 vs. $2712) ( P =0.002).
The diabetes GV care model reduced hospitalizations and had cost savings at 12 months, while it improved patients' diabetes-related quality of life and glucose control. Future studies should assess its lifetime cost-effectiveness through a randomized controlled trial.
我们评估了美国社区卫生中心（CHC）中未得到控制的糖尿病成人中小组就诊（GV）的经济影响。
在这项前瞻性对照试验中，我们在 5 个 CHC 中实施了 6 个月的小组就诊，并将干预组（n=49）与同一 CHC 中接受常规护理的对照组（n=72）进行比较。我们对患者病历进行了回顾，以获得基线时、6 个月（GV 实施期间）和 12 个月（实施后）的 6 个月的卫生保健利用数据。我们还收集了 CHC 费用和与 GV 相关的员工时间的每月记录。每位患者的总费用包括 CHC 的费用以及与员工时间和患者医疗保健使用相关的费用。对于组间比较，我们使用了 Wilcoxon 秩和检验和bootstrap 方法，即 bootstrap 广义估计方程模型。
GV 组在 6 个月时的住院率较低（平均值：GV：0.06 与对照组：0.24，发生率：6.1%与 19.4%）（P≤0.04），并且在 12 个月时的急诊就诊率也与对照组相似。实施 GV 的每位患者的费用为 1770 美元。干预组在 6 个月时比对照组多花费 1597 美元（3021 美元与 1424 美元），但在 12 个月时节省了 1855 美元（857 美元与 2712 美元）（P=0.002）。
糖尿病 GV 护理模式降低了住院率，并在 12 个月时节省了成本，同时改善了患者的糖尿病相关生活质量和血糖控制。未来的研究应通过随机对照试验评估其终生成本效益。
