Beck A, Scott J, Williams P, Robertson B, Jackson D, Gade G, Cowan P
Department of Research and Development, Colorado Permanente Medical Care Program, Denver, USA.
J Am Geriatr Soc. 1997 May;45(5):543-9. doi: 10.1111/j.1532-5415.1997.tb03085.x.
To compare the impact of group outpatient visits to traditional "physician-patient dyad" care among older chronically ill HMO members on health services utilization and cost, self-reported health status, and patient and physician satisfaction.
A 1-year randomized trial.
A group model HMO in the Denver Metropolitan area.
Three hundred twenty-one members aged 65 and older, randomized to a group visit intervention (n = 160) or to usual care (n = 161).
Patients with high health services utilization and one or more chronic conditions had monthly group visits with their primary care physician and nurse. Visits included health education, prevention measures, opportunities for socialization, mutual support, and for one-to-one consultations with their physician, where necessary.
Health services utilization and associated cost, health status, and patient and physician satisfaction.
Outcome measures obtained after a 1-year follow-up period showed that group participants had fewer emergency room visits (P = .009), visits to subspecialists (P = .028), and repeat hospital admissions per patient (P = .051). Group participants made more visits (P = .021) and calls (P = .038) to nurses than control group patients and fewer calls to physicians (P = .019). In addition, a greater percentage of group participants received influenza and pneumonia vaccinations (P < .001). Group participants had greater overall satisfaction with care (P = .019), and participating physicians reported higher levels of satisfaction with the groups than with individual care. No differences were observed between groups on self-reported health and functional status. Cost of care per member per month was $14.79 less for the group participants.
Group visits for chronically ill patients reduce repeat hospital admissions and emergency care use, reduce cost of care, deliver certain preventive services more effectively, and increase patient and physician satisfaction.
比较老年慢性病健康维护组织（HMO）成员接受门诊小组就诊与传统“医患二元组”护理对医疗服务利用和成本、自我报告的健康状况以及患者和医生满意度的影响。
为期1年的随机试验。
丹佛大都会区的一个团体模式健康维护组织。
321名65岁及以上的成员，随机分为门诊小组就诊干预组（n = 160）或常规护理组（n = 161）。
医疗服务利用率高且患有一种或多种慢性病的患者每月与他们的初级保健医生和护士进行小组就诊。就诊内容包括健康教育、预防措施、社交机会、相互支持，以及必要时与医生进行一对一咨询。
医疗服务利用情况及相关成本、健康状况、患者和医生满意度。
1年随访期后的结果指标显示，小组就诊参与者的急诊就诊次数（P = 0.009）、专科医生就诊次数（P = 0.028）和每位患者的再次住院次数（P = 0.051）较少。与对照组患者相比，小组就诊参与者与护士的就诊次数（P = 0.021）和通话次数（P = 0.038）更多，与医生的通话次数更少（P = 0.019）。此外，小组就诊参与者中接受流感和肺炎疫苗接种的比例更高（P < 0.001）。小组就诊参与者对护理的总体满意度更高（P = 0.019），参与的医生报告对小组就诊的满意度高于对个体护理的满意度。在自我报告的健康和功能状况方面，两组之间未观察到差异。小组就诊参与者每月每位成员的护理成本低14.79美元。
慢性病患者的小组就诊可减少再次住院和急诊护理的使用，降低护理成本，更有效地提供某些预防服务，并提高患者和医生的满意度。
