. 2016 Dec 5;32(3):325–344. doi: 10.1007/s11606-016-3922-9

Table 3.

Cost and Utilization Outcomes

			Utilization
Citation and patient population	Study design	Methodology score	ED visits	Hospitalizations	Urgent care visits	Medication use	Other healthcare use
Babamoto et al. 2009³³ Adult, type II diabetes	RCT	3 (5)	Change from baseline CHW grp: total visit decrease 11% Care management grp: total visit increase 40% Control grp: increase 15%^†	N/A	N/A	Change from baseline CHW grp: adherence increase 10% Care management grp: adherence decrease 22% ^† Control grp: decrease 17% ^†	N/A
Bryant-Stephens and Li 2008³⁵ Pediatric asthma	RCT Control not randomized	2 (5)	Mean ED visits before/after intervention HV grp: 1.99/1.02†* Obs. grp: 2.20/1.09† Control grp: 0.69/1.48 *HVE vs. CTRL: (p < 0.01)	Mean hosp. days before/after intervention HV grp: 0.66/0.33†* Obs. grp: 0.56/0.32† Control grp: 0.59/1.20 *HVE vs. CTRL: (p < 0.05)	Mean sick visits before/after intervention HV grp: 1.32/0.84† (p < 0.05)* Obs. grp: 1.31/1.05 Control: 0.67/1.35 *HVE vs. CTRL: (p < 0.05)	Albuterol use from baseline HV grp: decrease 25% † Obs. grp: decrease 22% Controller Meds use from baseline HVE grp: increase 3% Obs. grp: increase 2%	N/A
Fisher et al. 2009³⁶ Pediatric and adult asthma	RCT	4 (5)	For ED visits not followed by a hospitalization (1+ visits) Intervention grp: 64%, Control grp: 54% (p = 0.11)	Hospitalizations Intervention grp: 36.5% Control grp: 59.1% (p < 0.002)* One or more hospitalization during study period: Relative risk of hospitalization Intervention grp: 0.61 (0.45–0.83)* Main effect of intervention was significant (p < 0.001)* Controlling for admissions the prior year	N/A	N/A	N/A
Gary et al. 2009³⁷ Adult, type II diabetes mellitus	RCT	4 (5)	Relative risk 24 months after start Intervention grp: 0.77 (0.59–1.00)* Relative risk 36 months after start Intervention grp: 0.80 (0.62–1.03)	Relative risk 24 months after start Intervention grp: 0.91 (0.64–1.19) Relative risk 36 months after start Intervention grp: 0.79 (0.59–1.06)	N/A	N/A	N/A
Hopper et al. 1984³⁸ Adult, diabetes mellitus	RCT	2 (5)	Intervention grp: decreased -0.02 (-1.92–1.88) Control grp: increased 0.24 (-0.41–0.89)	N/A	N/A	N/A	Mean eye clinic visits per year change from baseline Intervention grp: increase 0.42 (0.12–0.72)† Control grp: decrease 0.02 (-0.28–0.25)
Hunter et al. 2004⁶¹ Adult, none	RCT	2 (5)	N/A	N/A	N/A	N/A	Relative risk of return visit Intervention grp: increase 35%, 1.35 (0.95–1.92)
Kangovi et al. 2014⁵¹ Adult, none	RCT	4 (5)	N/A	Percent sample readmitted: Intervention grp: 15.0% Control grp: 13.6%, (p = 0.68) Multiple readmissions: Intervention grp: 2.3% Control grp: 5.5% (p = 0.08)	N/A	N/A	Odds ratio: timely post-hospital primary care visit Intervention grp: 1.52 (1.03–2.23)* Odds ratio Multiple readmissions sub-group: Intervention grp: 0.4 (0.14–1.06)
Krieger et al. 1999⁶⁰ Adult, elevated blood pressure	RCT	4 (5)	N/A	N/A	N/A	N/A	Completions of follow-up visit Intervention grp: 39.4% higher from usual care (p < 0.001)*
Krieger et al. 2005⁵⁵ Pediatric asthma	RCT	4 (5)	N/A	N/A	High intensity grp: decreased 15% from baseline (p <0.001)† Low intensity grp: decreased 3.9% from baseline	N/A	N/A
Krieger et al. 2015⁵⁴ Adult asthma	RCT	4 (5)	N/A	N/A	Change in mean urgent care visits Intervention grp: 3.46 to 1.99 from baseline (p < 0.001)† Control grp: 3.30 to 1.96 from baseline (p < 0.005)† Intervention effect: -0.07 (p = 0.83)	Days of rescue medication (2-week frame) Intervention grp: 7.30 to 4.50 (p < 0.001)† Control grp: 7.40 to 6.08 (p < 0.005)† Intervention effect: -1.38 (p = 0.01)* Mean oral steroid use (12-month frame) Intervention grp: 3.94 to 1.16 (p = 0.21) Control grp: 5.68 to 2.45 (p = 0.33) Intervention effect: -1.18 (p = 0.42)	N/A
Kronish et al. 2014⁵⁷ Adult, reported occurrence of stroke or “mini-stroke” in past 5 years	RCT	4 (5)	N/A	N/A	N/A	Antithrombotic adherence: Intervention grp: increase 1% from baseline Control grp: stagnant 84% from baseline Not significant across groups (p = 0.79)	N/A
Martin et al. 2014⁵⁹ Pediatric persistent/uncontrolled asthma	RCT	4 (5)	N/A	N/A	N/A	Correct steps for inhaler use at 12 months Intervention grp (2): 14.2% more than control grp (p < 0.01)* Odds ratio for corticosteroid use Intervention grp (1): 0.2 (0.0–0.8)*	N/A
Nelson et al. 2011³⁹ Pediatric asthma	RCT	5 (5)	Relative risk compared to control Intervention grp: 0.94 (0.77–1.15)	Relative risk compared to control Intervention grp: 0.91(0.59–1.41)	N/A	N/A	Relative risk asthma monitoring primary care visit Intervention grp: 1.21 (1.04–1.41)* Relative risk non-asthma primary care visit Intervention grp: 1.47 (1.04–2.08)*
Parker et al. 2008⁵³ Pediatric asthma	RCT	3 (5)	N/A	N/A	Odds ratio unscheduled medical care intervention effect Intervention grp: 0.4 (p = 0.004)*	N/A	N/A
Rothschild et al. 2014⁵⁶ Adult, type II diabetes treated with at least 1 oral hypoglycemic agent	RCT	3 (5)	N/A	N/A	N/A	No change in medication adherence observed Overlapping confidence intervals	N/A
Wang et al. 2012³⁴ Adult, at least one chronic illness, including mental health and addiction	RCT	4 (5)	Incident rate ratio of annual visit Intervention grp: 0.49 (0.34–0.70)*	Incidence rate ratio of Hospitalization Intervention grp: 0.89 (0.44–1.82)	N/A	N/A	N/A
Adair et al. 2012⁴⁷ Adult, hypertension, diabetes, or heart failure	Pre-post	Moderate (1)	Total number of visits decreased 310 to 259 (year during intervention) to 269 (year post)	Total number decreased from 188 to 166 (year during intervention) to 177 (year post)	N/A	No change in ACEI/ARB use (p = 0.549); aspirin use increase 10% from baseline (p < 0.001)†	N/A
Ferrer et al. 2013⁴⁸ Adult, high-risk patients	Pre-post	Weak (3)	12% total visit increase from baseline	24% total visit decrease from baseline	N/A	N/A	N/A
Fox et al. 2007⁴⁵ Pediatric asthma	Pre-post	Weak (2)	18.3% total visit decrease from baseline† (p < 0.0001)	6.9% total visit decrease from baseline† (p < 0.0001)	30.8% total visit decrease from baseline† (p < 0.0001)	Total count frequent use of rescue medication: 30.5% decrease from baseline† (p < 0.0001)	N/A
Margellos-Anast et al. 2012⁴¹ Pediatric asthma	Pre-post	Weak (3)	Median number of ED visits decreased from 2.0 to 0.0 (p < 0.0001)†	Median number of hospitalizations 0.0 to 0.0 (p < 0.0001)† Range decreased 0–6 at baseline to 0–3 follow-up	Median number of urgent care visits1.0 to 1.0 (p = 0.003)† Range decreased 0–12 at baseline to 0–8 at follow-up	N/A	Median general clinic visits increased from 2.5 to 3.5 (p = 0.9215)
Michelen et al. 2006⁴² Pediatric, none	Pre-post	Weak (2)	Pearson correlation associated with decrease in ED use Providing health education: r = 0.299 (p < 0.000)† Teaching patients to use healthcare system: r = 0.259 (p < 0.000)† Providing counseling on social/emotional issues: r = 0.408 (p < 0.001)†	N/A	N/A	N/A	N/A
Postma et al. 2011⁴³ Pediatric asthma	Pre-post	Strong (0)	Mean visits per patient decreased 0.46 to 0.22† (p < 0.005)	Mean admissions per patient decreased 0.15 to 0.01 (p < 0.0005)†	N/A	Rescue medication adherence: 32.5% increase from baseline (p < 0.0005)† Medication refilled before running out: 34.4% increase from baseline (p < 0.0005)†	N/A
Primomo et al. 2006⁴⁶ Pediatric asthma	Pre-post	Weak (3)	5% total visit decrease from baseline (p = 0.3)	12.9% total visit decrease from baseline (p = 0.01)†	Total count unscheduled doctor visits: increase 4% (p = 0.66)	Total count long-term asthma control prescription: 7% increase (p = 0.224) Quick relief prescriptions: 10% increase (p = 0.028)†	N/A
Turyk et al. 2013⁴⁴ Pediatric asthma	Pre-post	Moderate (1)	22.9% decrease from baseline (p < 0.0001)†	11% decrease from baseline (p < 0.0001)†	26.7 decrease from baseline (p < 0.0001)†	Controller use: 13.6% increase from baseline (p < 0.0001)†	N/A
Bryant-Stephens et al. 2009⁴⁹ Pediatric asthma	Cohort	5 (9)	30% decrease in mean number of visits per year per patient from baseline† (2.3 to 1.6) (p < 0.001)	53% decrease in mean number of visits per year per patient from baseline (0.89–0.43) (p < 0.001)†	N/A	Total frequency in albuterol use: 0.01 decrease (p = 0.89)	N/A
Enard and Ganelin 2013⁵⁰ Pediatric and adult, none	Cohort	7 (9)	>1 Primary care-related ED visits prior to intervention: mean visit decreased by 0.9 per patient† (p < 0.001) >5 Primary care-related ED visits prior to intervention: mean visits decrease by 3.4 per patient (p < 0.001)	N/A	N/A	N/A	N/A
Felix et al. 2011⁵² Adult, long-term care needs	Cohort	8 (9)	N/A	Intervention grp: inpatient hospital costs decreased $433 per person; outpatient hospital decreased $6 Comparison grp: inpatient hospital costs decreased $713 per person; outpatient hospital costs increased $152 per patient	N/A	N/A	N/A
Freeborn et al. 1978⁶² Pediatric and adult, none	Cohort	7 (9)	N/A	N/A	N/A	N/A	Ambulatory care Intervention groups: 146% increase for males (p < 0.001)* 139% increase for females (p < 0.004)*
Johnson et al. 2012⁵ Not stated, none	Cohort	7 (9)	Intervention grp: mean visits per patient decreased from 5.9 ($1,453 avg.) to 1.8 post intervention ($570 avg.) Comparison grp: mean visits per patient decreased from 4.5 ($1,051 avg.) to 1.0 post intervention ($272 avg.)* Comparison group decreased significantly across the study period (p < 0.01)	Admissions per patient Intervention grp: mean 0.4 visits ($2358 avg.) to 0.1 visits post intervention ($410 avg.)* Comparison grp: 0.1 visits ($1,184 avg.) to 0.1 visits post intervention ($458 avg.) Intervention group decreased significantly across study period (p < 0.01)	N/A	Non-narcotic prescriptions per patient Intervention grp: 49.8 per person ($2,409 avg.) to 18.6 per person ($848) post intervention Comparison grp: 14.2 per person ($429 avg.) to 9.1 per person post intervention ($396 avg.)* Narcotic prescriptions per patient Intervention grp: 6.6 per person ($180 avg.) to 2.3 per person ($75 avg.) post intervention Comparison grp: 1.8 per person ($31 avg.) to 0.8 per person ($22 avg.) Comparison group decreased significantly across study period (p < 0.01)	N/A
Roth et al. 2012⁵⁸ Adult, HIV-positive	Cohort	7 (9)	N/A	N/A	N/A	Odds ratio adherence to HIV med Intervention grp: OR 1.83 (p = 0.046)* Viral load studies more likely in intervention group OR 3.05 (p = 0.04)* Viral load under control more likely OR 2.01 (p = 0.011)*	N/A
Brown et al. 2012⁶³ Adult, type II diabetes	cost-effectiveness	14 (19)	N/A	N/A	N/A	N/A	N/A
Kattan et al. 2005⁴⁰‡ Pediatric, physician-diagnosed asthma	cost-effectiveness	16 (19)	Difference in mean ED visits: intervention vs. control: −0.10 (p = 0.30)	Difference in mean inpatient days: intervention vs. control: -0.11 (p = 0.39)	Difference in mean unscheduled visits: 19% decrease relative to control (p = 0.03)*	Difference in mean inhalers: intervention vs. control: -0.86 (p < 0.001)*	Difference in mean scheduled medical visits: intervention vs. control: -0.07 (p = 0.62)
Mirambeau et al. 2013³⁰ Not stated, not stated	cost-effectiveness	13 (19)	N/A	N/A	N/A	N/A	N/A
Ryabov 2014⁶⁴ Adult, type II diabetes	cost-effectiveness	13 (19)	N/A	N/A	N/A	N/A	N/A

*Indicates significance between groups (control-intervention)

†Indicates significance within groups (pre-post single sample)

‡This cost-effectiveness study also included some outcome results reported relative to a randomized control and is considered an RCT in discussions of those outcomes