Implementing group medical visits for older adults at group health cooperative.
Implementing group medical visits for older adults at group health cooperative.
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DOI：
10.1111/j.1532-5415.2009.02628.x
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发表时间：
2010-01
影响因子：
6.3
通讯作者：
Phelan EA
中科院分区：
文献类型：
--
作者：
Levine MD;Ross TR;Balderson BH;Phelan EA
在20世纪90年代在科罗拉多州凯撒医院进行的两项随机对照试验中，老年人集体就诊（由初级保健团队领导的一组患者每月进行非特定疾病的集体医疗预约）被证明可以降低成本，减少住院率，提高患者和提供者的满意度。作为转化工作的一部分，该小组访问干预在华盛顿州西雅图的一个交付系统中进行了复制，并在干预的第一年测量了总医疗保健费用的日志。利用率和患者和医生满意度是次要结果。为了进行成本和利用分析，回顾性病例对照设计比较了221例65岁及以上且在过去18个月内门诊使用率高的患者，以及从未参与干预的诊所随机选择的1015例对照患者。对照组与前18个月的初级保健就诊次数相匹配。与对照组相比，干预组患者的总费用没有统计学差异（8,845美元对10,288美元，p=0.11），包括住院和门诊就诊在内的利用率也没有统计学上的显著差异。然而，患者和提供者的满意度很高。这种转化的努力并没有证明原始疗效试验的成本节约。对这些不同结果的可能解释可能与参与者的差异以及两种传递系统之间的差异有关。
In a pair of randomized controlled trials in Kaiser Colorado in the 1990s, Group Visits for older adults (monthly non disease-specific group medical appointments for a cohort of patients led by primary care teams) were proven to reduce costs, decrease hospitalizations, and improve patient and provider satisfaction. As part of a translational effort, this Group Visit intervention was replicated in a delivery system in Seattle, WA, and the log of total health care costs measured in the first year of the intervention. Utilization and patient and physician satisfaction were secondary outcomes. For the cost and utilization analysis, a retrospective case-control design compared 221 case patients 65 years of age and older with high outpatient utilization in the previous 18 months with 1,015 control patient selected randomly from clinics not participating in the intervention. Controls were matched to cases on the number of primary care visits in the prior 18 months. Total costs were not statistically different for intervention patients compared to controls ($8,845 vs. $10,288, p=0.11), nor were there statistically significant differences in utilization, including hospital admissions and outpatient visits. However, patient and provider satisfaction was high. This translational effort did not demonstrate the cost savings of the original efficacy trials. Possible explanations for these divergent results may have to do with differences in those who participated and differences between the two delivery systems.
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影响因子：
3
作者：
Fishman, PA;Goodman, MJ;Rosetti, MCO
通讯作者：
Rosetti, MCO
影响因子：
120.7
作者：
Murray, M;Berwick, DM
通讯作者：
Berwick, DM
影响因子：
5.7
作者：
Clancy, Dawn E.;Huang, Peng;Okonofua, Eni;Yeager, Derik;Magruder, Kathryn Marley
通讯作者：
Magruder, Kathryn Marley
DOI：
10.1111/j.1532-5415.1997.tb03085.x
发表时间：
1997-05-01
影响因子：
6.3
作者：
Beck, A;Scott, J;Cowan, P
通讯作者：
Cowan, P
影响因子：
6.1
作者：
TOBIN, J
通讯作者：
TOBIN, J