A Randomized Controlled Trial of Academic Group Practice
Improving the Operation of the Medicine Clinic
- Harold I. Goldberg, MD;
- David I. Cohen, MD;
- Charles O. Hershey, MD;
- I-Lind Hsiue, MS;
- Dan K. Porter, MSSA;
- Christine E. McLaren, PhD
- From the Department of Medicine, Cleveland Metropolitan General Hospital (Drs Goldberg, Cohen, and Hershey, Ms Hsiue, and Mr Porter), and the Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland (Dr McLaren). Dr Goldberg is now with the Department of Medicine, University of Washington, Seattle; Dr Cohen, with the Departments of Medicine and Community Medicine, Mount Sinai School of Medicine, New York; Dr Hershey, with the Department of Medicine, State University of New York, Buffalo; and Dr McLaren, with the Department of Mathematics, Moorhead State University, Moorhead, Minn.
Abstract
We conducted a controlled trial of the adoption of a group-practice model within an academic department of medicine. Ongoing randomization yielded similar groups of patients and residents. To determine the effect of the intervention on medicine-clinic operation, we monitored the hospital outpatient activity of 28 residents and 2299 patients during an 11-month study period. The group-practice clinics generated 20% more patient encounters per month than did the traditional, control clinics (328 vs 273 encounters), primarily because twice as many voluntary, overflow clinic sessions were scheduled (20.2 vs 9.7 sessions). Yet, because group-practice registration was decentralized, patients spent 15% less time in completing scheduled visits (93.2 vs 109.9 minutes). Regular utilizers of the group practices made 7% more scheduled clinic visits on average (3.27 vs 3.05 visits), but 39% fewer walk-in visits (0.14 vs 0.23 visits). Hospital-wide, continuity of care was not affected. We conclude that adoption of a group-practice model at our institution improved clinic productivity, enhanced patient flow, and decreased unscheduled clinic visits.
(JAMA 1987;257:2051-2055)
Footnotes
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Reprint requests to Harborview Medical Center, ZA-60,325 Ninth Ave, Seattle, WA 98104 (Dr Goldberg).
