Group Medical Appointments Get Another Look

Michelle Wilson Berger for HealthLeaders Media , June 7, 2012

Measuring success
Starting a group medical appointment isn't without its challenges, however. Cheng remembers the growing pains well. "You're like the new kid on the block and you're going against the establishment," he says. Sure, this model has gained momentum, yet it's still counter to the notion of one-on-one appointments, and it's certainly not for everyone, patients and physicians alike.

Use data to show that the model works, Cheng suggests. His participants fill out a 13-question survey about topics like how in control of their health they feel. They do it three times: before they start, four weeks in, and three months later. "We wanted to measure the effect of this program on the patient. That's where it all starts," he says. "We're measuring patient activation."

Because the Palo Alto program is so new, Cheng has only anecdotal evidence—friendships formed, active listening during sessions—that it's working. Yet, backed by support from his organization, he has the green light to pursue additional patients.

When Neuwirth was at Harvard Vanguard, they used a Press Ganey survey to determine patient satisfaction. The results surprised even him.

"Patient satisfaction in the group visit was as good as the satisfaction in the individual visit." In some areas, such as how well patients felt their physician knew them, the group visits actually scored higher. Sumego recommends a combination of hard data and observation to measure a program's success. She also suggests varying metrics by topic—for example, emergency-room use for asthmatics or HgA1c levels for diabetics. "You're customizing shared medical appointments around the disease that you're managing, and every disease has a different quality metric," she says.

For institutions embarking on shared medical appointments, these physicians offer three pieces of advice: pick high-impact goals that doctors at the institutions are passionate about, establish the right team, and plan ahead. "Don't rush off half-cocked without getting all your ducks lined up. You need administrative support. You need a well-designed group program. You need the right team and the right facilities," says Noffsinger. "Design it correctly and you will really enjoy your experience. If you try to shortcut the process..." he pauses. "You'll get frustrated and you'll make the inaccurate conclusion that group visits won't work for you when, in fact, they will, if done properly."

Michele Wilson Berger is a contributing writer for HealthLeaders Media.

This article appears in the May 2012 issue of HealthLeaders magazine.

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2 comments on "Group Medical Appointments Get Another Look"

M. Bennet Broner, PhD (6/7/2012 at 1:07 PM)
This is deja vu all over again. Around 1993 I developed a group health maintence group concept focused around a psychologist and a health educator. I shopped the idea to the Center for Family Practice at the University of Alabama, Birmingham; and at Cooper Green Mercy Hospital (county run)and both saw no practical need for it. I wonder if they'd feel the same today? Presently, I am redeveloping the program for a non-medical non-profit.

Adrian Scipione (6/7/2012 at 9:46 AM)
I can't imagine this improving the care that the patient receives. It is highly improbable that every single patient in that group session would be as open and honest with their physician as if they were one on one, particularly if they have concerns about one treatment plan over another. It appears to me that, outside of a few cases that would be enhanced by a group meeting (ie. educating the patient on what to expect from their knee replacement surgery), this would stifle a dialogue in instances where that is very important. It is entirely a different matter where the course of treatment and the informed consent has already been obtained and you are merely going through the specific process and educating the patients on what they can expect. I am a non-believer who needs to be convinced about the advantages of this.




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