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

J Am Geriatr Soc. 2004 Sep;52(9):1463-70. doi: 10.1111/j.1532-5415.2004.52408.x.


Objectives: 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.

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

Setting: Nonprofit group model HMO.

Participants: 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.

Intervention: Monthly group meetings held by patients' primary care physicians.

Measurement: 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.

Conclusion: 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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Adult
  • Aged
  • Ambulatory Care / organization & administration*
  • Chronic Disease / psychology
  • Chronic Disease / therapy*
  • Colorado
  • Disease Management*
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Geriatric Assessment
  • Health Care Costs / statistics & numerical data
  • Health Maintenance Organizations / organization & administration*
  • Health Services Research
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Models, Organizational*
  • Patient Education as Topic / organization & administration
  • Patient Satisfaction
  • Primary Health Care / organization & administration
  • Program Evaluation
  • Quality of Life
  • Self Efficacy
  • Self-Help Groups / organization & administration*