OPEN IN READ APP
JOURNAL ARTICLE
RANDOMIZED CONTROLLED TRIAL

Reducing emergency visits in older adults with chronic illness. A randomized, controlled trial of group visits

E A Coleman, T B Eilertsen, A M Kramer, D J Magid, A Beck, D Conner
Effective Clinical Practice: ECP 2001, 4 (2): 49-57
11329985

CONTEXT: Emergency department utilization by chronically ill older adults may be an important sentinel event signifying a breakdown in care coordination. A primary care group visit (i.e., several patients meeting together with the provider at the same time) may reduce fragmentation of care and subsequent emergency department utilization.

OBJECTIVE: To determine whether primary care group visits reduce emergency department utilization in chronically ill older adults.

DESIGN: Randomized trial conducted over a 2-year period.

SETTING: Group-model HMO in Denver, Colorado.

PATIENTS: 295 older adults (> or = 60 years of age) with frequent utilization of outpatient services and one or more chronic illnesses.

INTERVENTION: Monthly group visits (generally 8 to 12 patients) with a primary care physician, nurse, and pharmacist held in 19 physician practices. Visits emphasized self-management of chronic illness, peer support, and regular contact with the primary care team.

MEASURES: Emergency department visits, hospitalizations, and primary care visits.

RESULTS: On average, patients in the intervention group attended 10.6 group visits during the 2-year study period. These patients averaged fewer emergency department visits (0.65 vs. 1.08 visits; P = 0.005) and were less likely to have any emergency department visits (34.9% vs. 52.4%; P = 0.003) than controls. These differences remained statistically significant after controlling for demographic factors, comorbid conditions, functional status, and prior utilization. Adjusted mean difference in visits was -0.42 visits (95% CI, -0.13 to -0.72), and adjusted RR for any emergency department visit was 0.64 (CI, 0.44 to 0.86).

CONCLUSION: Monthly group visits reduce emergency department utilization for chronically ill older adults.

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Available on the App Store

Available on the Play Store
Remove bar
Read by QxMD icon Read
11329985
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"