A randomized trial of group outpatient visits for chronically ill older HMO members: The cooperative health care clinic
A randomized trial of group outpatient visits for chronically ill older HMO members: The cooperative health care clinic
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DOI：
10.1111/j.1532-5415.1997.tb03085.x
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发表时间：
1997-05-01
影响因子：
6.3
通讯作者：
Cowan, P
中科院分区：
文献类型：
--
作者：
Beck, A;Scott, J;Cowan, P
目的：在老年慢性病HMO成员中，比较传统的“医患二元制”护理对集体门诊的影响，对卫生服务利用和成本、自我报告的健康状况以及患者和医生的满意度。设计：一项为期1年的随机试验。321名年龄在65岁及以上的成员，被随机分配到一组访问干预（n = 160）或常规护理（n = 161）。高卫生服务利用率和一种或多种慢性疾病的患者每月与他们的初级保健医生和护士进行集体访问。访问内容包括健康教育、预防措施、社会化机会、相互支持以及必要时与医生进行一对一咨询。测量：卫生服务利用率和相关费用、健康状况以及患者和医生的满意度。1年随访期后获得的结果指标显示，小组参与者的急诊室就诊次数较少（P = 0.009），亚专科医生就诊（P = 0.028），以及每例患者重复住院（P = 0.051）。与对照组患者相比，组参与者对护士的访问（P =.021）和呼叫（P =.038）更多，对医生的呼叫更少（P =.019）。此外，接受流感和肺炎疫苗接种的组参与者比例更高（P
OBJECTIVE: 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.DESIGN: A 1-year randomized trial.SETTING: A group model HMO in the Denver Metropolitan area.PARTICIPANTS: Three hundred twenty-one members aged 65 and older, randomized to a group visit intervention (n = 160) or to usual care (n = 161).INTERVENTION: 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.MEASUREMENTS: Health services utilization and associated cost, health status, and patient and physician satisfaction.RESULTS: 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