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Abstract title: Outcomes of Group Outpatient Clinic Visits

Author(s):
MR Rittman - Gainesville VAMC Brain Rehabilitation Research Center VA HSR&D/RR&D RORC
MV Graham - North Florida/South Georgia Veterans Health System
B Stidham - Brain Rehabilitation Research Center of Excellence
P Rajasekhar - North Florida/South Georgia Veterans Health System
M White - North Florida/South Georgia Veterans Health System

Objectives: The purpose of this study was to evaluate outcomes of using scheduled monthly group outpatient clinic visits instead of 15-20 minute individual visits. The group model of outpatient care delivery was developed by Kaiser Permanente in Colorado. This project was the first trial of the CHCC model in the Veterans Health Administration to our knowledge.

Methods: A randomized clinical trial was used to evaluate outcomes. A total of 95 subjects were enrolled and randomly assigned to either the treatment or control group with 48 subjects in the intervention group and 47 subjects in the control group. The intervention included monthly 2-hour group clinic visits that incorporated patient education, provider visits, and socialization. The presentation will a brief description the intervention and report on outcomes at one year using the following outcomes: Health Related Quality of Life (SF36V), management of illness and health (Self Efficacy Scale), depression (Geriatric Depression Scale), patient and provider satisfaction, resource utilization.

Results: Patients in the group clinics reported having less pain and the pain they did experience interfered less in their daily activities (p=.04). Compared with the control group, patients in the treatment group reported they had more energy and less fatigue at a statistically significant level (p=.02). Participants in the group clinics also reported that physical health or emotional problems interfered less in social activities with family or friends (p=.01). No statistical differences between groups were found on physical functioning, general health, role: emotional and mental health. Patients in the group clinics reported an increase in their ability to perform household chores, shop, and run errands despite health problems (p=.04). In addition, they reported an improvement in social and recreational activities with friends and family (p=.01) and were more adherent in taking medication according to the prescribed regimen (p=. 0475). Patients in group clinics reported that their provider was more attentive to their needs (p=.02) and were more satisfied with the provider but this failed to reach statistical significance (p=.06).

Conclusions: These positive outcomes support the benefits to patients and providers for the group clinic model and provide strong justification for future studies of this model of care in the VA. Evaluation of outcomes over a longer period of time may yield even more positive results.

Impact statement: Four group clinics are continuing and plans are underway to obtain additional funding for a larger, multi-site trial.