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. 2021 Dec 2;18(23):12726. doi: 10.3390/ijerph182312726

Table 1.

Characteristics of studies included in systematic review a.

Primary Author, Year Sample Study Setting N Mean Age; Sex, %; Race/Ethnicity, % b Group Care Model: Type; Frequency, Duration; Number Patients Per Session (n)2 Triple Aim 1: Patient Experience Triple Aim 2: Population Health Triple Aim 3: Costs
Pregnancy
Ford, 2002 Pregnant adolescents Five clinics in MI 282 Mean age: 18 years; 100% female; 94% African American, 4% Caucasian, 2% Other Group and peer partner assignment for duration of prenatal care; groups met at scheduled clinic time; n = 6–8 N/A Significant:

  • Lower rate of low birth weight

Non-significant:

  • Rapid-repeat pregnancy

 N/A
Felder, 2017 (See Ickovics, 2016) 1135 Mean age: 18 years; 100% female; 58% Latina, 34% Black, 8% Other (See Ickovics, 2016) N/A Significant:

  • Greater reduction in perinatal depressive symptoms

 N/A
Ickovics, 2007 Pregnant adolescents and young adults Two university-affiliated hospitals in CT and GA 1047 Mean age: 20 years; 100% female; 80% African American, 13% Latina, 6% White, 1% Mixed or Other CP and CPP; 10 prenatal sessions, 120 min each; average n = 8 Significant:

  • Lower likelihood of suboptimal prenatal care

  • Better preparation for labor and delivery

  • Increased patient satisfaction with prenatal care

Non-significant:

  • Readiness for infant care

 Significant:

  • Decreased preterm birth

  • Increased breastfeeding initiation

Non-significant:

  • Birth weight

  • Prenatal distress

 Non-significant:

  • Total raw costs of prenatal care

  • Delivery care costs

  • NICU admission
Ickovics, 2011 (See Ickovics, 2007) N/A Significant:
Among subgroup with high psychosocial stress only:

  • Decreased depression in third trimester

  • Decreased depression postpartum

 N/A
Ickovics, 2016 Pregnant adolescents and young adults Fourteen urban health centers in NY 1148 Mean age: 19 years; 100% female; 58% Latina, 34% Black, 8% White or Other CPP, 10 prenatal sessions, 120 min each; n = 8–12 N/A Significant:

  • Decreased small for gestational age

Non-significant:

  • Preterm birth

  • Low birth weight

  • Breastfeeding

  • STI incidence

  • Rapid repeat pregnancy

 Non-significant:

  • NICU admission
Kennedy, 2011 Pregnant women on TRICARE Two military clinics 322 Mean age: 25 years; 100% female; 59% White, 19% African American, 10% Latina, 5% Asian/Pacific Islander, 7% Other CP; 9 prenatal sessions and 1 postpartum reunion; n = 6–12 Significant:

  • Increased adequacy of care

  • Increased patient satisfaction

 Non-significant:

  • Breastfeeding initiation

  • Breastfeeding 3-months postpartum

  • Preterm birth

  • Low birth weight

  • Perceived stress

  • Prenatal depression

  • Postpartum depression

 Non-significant:

  • NICU admission
Kershaw, 2009 (See Ickovics, 2007) N/A Significant:

  • Decreased rapid repeat pregnancy

  • Increased condom use

  • Decreased unprotected sex

Non-significant:

  • STI incidence

 N/A
Magriples, 2015 (See Ickovics, 2016) 984 Mean age: 19 years; 100% female; 64% Black, 32% Latina, 4% Other (See Ickovics, 2016) N/A Significant:

  • Less weight gain during pregnancy

  • Greater weight loss postpartum

 N/A
Mazzoni, 2018 Pregnant women with Type II or gestational diabetes Two diabetes clinics in CO and MO 78 Mean age: 31 years; 100% female; 53% Hispanic, 39% African American, 8% White 4-session curriculum delivered to rotating cohort; every two weeks, 90–120 min each; n = 2–10 N/A Non-significant:

  • Prenatal depression

  • Postpartum depression

 N/A
Diabetes
Berry, 2016 Low-income adults with uncontrolled diabetes Community-based health center in NC 80 Mean age: 51 years; 89% female, 11% male; 77% Black, 18% White, 2% Hispanic, 1% Asian Pacific, 1% American Indian Five group classes; every 3 months for 15 months Significant:

  • Increased willingness to discuss personal problems with provider

  • Better perceived general health

 Significant:

  • Decreased HbA1c

  • Decreased HDL (control group only)

  • Decreased triglycerides

  • Decreased resting heart rate

  • Increase in stretching and strengthening exercises

Non-significant:

  • LDL

  • Blood pressure

  • Blood glucose monitoring

  • Aerobic activity

  • Eating breakfast

 Non-significant:

  • Number of medical visits

  • ED visits

  • Hospital admission

  • SNF admission
Clancy, 2007 Low-income adults with uncontrolled Type II diabetes Primary medical center in SC 186 Mean age: 56 years; 72% female, 28% male; 83% African American, 17% Other CHCC; monthly visits for 1 year, 120 min each; n = 14–17 Significant:

  • Better adherence to ADA process of care indicators

  • Increased breast and cervical cancer screening

 Non-significant:

  • HbA1c levels

  • Blood pressure

  • HDL

  • LDL

 N/A
Clancy, 2008 (See Clancy 2007) N/A N/A Significant:

  • Lower total expenditures

  • Lower ED expenditures

  • Lower outpatient charges due to fewer specialty-care visits
Cohen, 2011 Adults with uncontrolled Type II diabetes and cardiovascular risk VA Medical Center 99 Mean age: 70 years (group care), 67 years (usual care); 2% female, 98% male VA-MEDIC-E; weekly for 4 weeks then monthly for 5 months, 120 min; n = 4–6 Non-significant:

  • Quality of life

 Significant:

  • Higher rate of A1C target goal attainment

  • Higher rate of systolic blood pressure goal attainment

Non-significant:LDL

  • Weight

  • Diet

  • Exercise

  • Blood glucose monitoring

 N/A
Cole, 2013 Adults with prediabetes TRICARE beneficiaries in San Antonio, Texas 65 Mean age: 58 years; 46% females, 54% males; 64% Caucasian, 19% Hispanic, 17% African American Nutrition-focused shared medical appointments; monthly for 3 months, 90 min each; n = 6–8 N/A Non-significant:

  • Weight loss

  • BMI

  • Blood pressure

  • HbA1c

  • Fasting blood glucose

  • Total cholesterol

  • LDL

  • HDL

  • Triglycerides

  • Exercise

 N/A
Crowley, 2014 (See Edelman 2010) N/A Significant:

  • Lower LDL

  • Lower total cholesterol

Non-significant:

  • Triglycerides

  • HDL

 N/A
Edelman, 2010 Adults with uncontrolled Type II diabetes and hypertension Two VA medical centers in NC and VA 239 Mean age: 63 years (group care), 61 years (usual care); 5% female, 95% male; 58% African American, 36% White, 5% Other Group medical clinic; every 2 months for 12 months, 12 min each; n = 7–9 N/A Significant:

  • Lower systolic blood pressure

  • Lower diastolic blood pressure

Non-significant:

  • HbA1c levels

 Significant:

  • Fewer ED visits

  • Fewer primary care visits

Non-significant:

  • Hospital admissions
Eisenberg, 2019 (See Edelman 2010) N/A Non-significant:

  • •BMI

 N/A
Gutierrez, 2011 Hispanic adults with Type II diabetes Family medicine residency clinic in TX 103 100% Hispanic Shared medical appointments; twice per month for 9 months, 120 min each; mean n = 9 N/A Significant:

  • Decreased HbA1c levels

 N/A
Schillinger, 2009 Adults with uncontrolled type II diabetes County-run clinics in CA 339 Mean age: 56 years; 59% female, 41% male; 47% White/Latino, 23%Asian, 21% African American, 8% White/Non-Latino, 1% Other Group medical visits; 9 monthly sessions, 90 min each; n = 6–10 Non-significant:

  • Quality of life

 Significant:

  • Improved self-monitoring of blood glucose

Non-significant:

  • HbA1c levels

  • Blood pressure

  • BMI

  • Diet

  • Physical activity
Taveira, 2010 Adults with uncontrolled Type II diabetes VA medical center in RI 109 Mean age: 62 years (group care), 67 years (usual care); 5% female, 95% male; 91% White, 9% Other VA-MEDIC;4 weekly sessions, 60 min each; n = 4–8 N/A Significant:

  • More achieved target HbA1c

  • More achieved target blood pressure

  • Improved blood glucose self-monitoring

  • Improved blood pressure self-monitoring

Non-significant:

  • Lipid levels

  • BMI

  • Diet adherence

  • Physical activity

 N/A
Taveira, 2011 Adults with Type II diabetes and comorbid depression VA medical center in RI 88 Mean age: 60 years (group care), 61 years (usual care); 2% female, 98% male; 99% White, 1% Other VA-MEDIC-D; 4 weekly sessions, 120 min each, followed by 5 monthly, 90 min each; n = 4–6 N/A Significant:

  • More reached target HbA1c

Non-significant:

  • Lipid levels

  • Blood pressure

  • Depression

 Non-significant:

  • ED visits

  • Hospital admissions
Vaughan, 2017 Low-income Hispanic adults with Type II diabetes Community clinic in TX 50 Mean age: 51years (group care), 48 years (usual care); 80% female, 20% male; 100% Hispanic Group visits with CHWs integrated as part of leadership team; 6 monthly sessions, 180 min each; maximum n = 10 Significant:

  • Better guideline concordance for any weight loss, retinal eye exams, comprehensive foot exams, urine microalbumin, mammogram screening

Non-significant:

  • Colon cancer screening

  • Cervical screening

 Significant:

  • More reached target HbA1c

Non-significant:

  • Lipids

  • Blood pressure

  • BMI

 N/A
Wagner, 2001 Adults over ≥30 years with diabetes Group model HMO in WA 707 Mean age: 61years (group care), 60 years (usual care); 47% female, 53% male; 69% White, 31% Other Group chronic care clinics; once every 3 to 6 months for 2 years; n = 6–10 Significant:

  • Increased preventive health procedures

  • Increased likelihood of microalbumin test

  • Higher participation in and perceived helpfulness of patient education

  • Better general health

  • Reduced bed disability days

Non-significant:

  • Medical care satisfaction

  • Diabetes care satisfaction

  • Retinal eye exam

  • Foot exam

  • Restricted activity days

 Non-significant:

  • Physical function

  • Depression

  • HbA1C

  • Total cholesterol

 Significant:

  • Fewer ED visits

  • Fewer specialty care visits

  • Non-significant:

  • Primary care visits

  • Hospital admissions

  • Total health care costs
Wu, 2018 Adults with uncontrolled type II diabetes and either hypertension, active smoking or hyperlipidemia Three VA Hospitals in RI, CT, and HI 250 Mean age: 65 years; 4% female, 96% male VA-MEDIC;
4 weekly sessions followed by 4 booster sessions held once every 3 months, 120 min each; n = 4–6		 Non-significant:

  • Quality of life

 Non-significant:

  • HbA1c

  • Systolic blood pressure

  • LDL

  • Coronary event risk

 Significant:

  • Reduction in health care costs post-study

Non-significant:

  • Total per-patient-cost during study

  • ED visits

  • Hospital admissions
Other Chronic Health Conditions
Beck, 1997 Chronically ill older adults (≥65 years) Group model HMO in CO 321 Mean age: 72 years (group care), 75 years (usual care); 66% female, 34% male CHCC; 12 monthly sessions, 120 min each; average n = 8 Significant:

  • Increased patient satisfaction

  • Increased vaccination rates

Non-significant:

  • Self-reported health status

 Non-significant:

  • Depression

  • Mobility

  • Functional status

 Significant:

  • Fewer same day internal medicine visits

  • Fewer specialist visits

  • Fewer ED visits

Non-significant:

  • Hospital admissions

  • Hospital charges

  • Skilled nursing facility admissions

  • Visiting nurse services
Coleman, 2001 Chronically ill older adults (≥60 years) Group model HMO in CO 295 Mean age: 74 years; 59% female, 41% male CHCC;
120 min; 24 monthly sessions, 120 min each; n = 8–12		 N/A N/A Significant:

  • Fewer ED visits

  • Fewer hospitalizations

  • Higher overall outpatient utilization

Non-significant:

  • Primary care visits
Collins, 2013 Adults with hearing loss VA audiology clinic in WA 644 Mean age: 66 years; 2% female, 98% male Drop-in group medical appointment; one visit for fitting, 60 min, and one follow-up ~3–5 week later, 75 min (randomized separately); maximum n = 6 Significant:

  • Less satisfied with amount of time with audiologist, quality of time spent with audiologist, amount of hands-on practice with aids

 Non-significant:

  • Hearing aid adherence

  • Hearing-related handicap

  • Communication strategies

  • Hearing aid outcomes

  • Hearing aid satisfaction

 Significant:

  • Lower total costs per patient

  • Lower cost per patient for individual fitting

  • Lower cost per patient for follow-up

Non-significant:

  • Number of unplanned visits

  • Cost of unplanned visits
Griffin, 2009 Adults on warfarin therapy Anticoagulation clinic in ambulatory care center in IL 153 Mean age: 75 years (group care), 67 years (usual care) CHCC; twice weekly for 16 weeks, 60 min each; average n = 6 N/A Non-significant:

  • International normalized ratios within or near therapeutic range

  • Thromboembolic or hemorrhagic bleeding events (none documented)

 N/A
Masley, 2001 Adults with coronary artery disease and high lipid levels Four community outpatient clinics in 3 cities in WA 97 Mean age: 66 years (group care), 64 years (usual care); 30% female, 70% male CHCC; 14 group visits over 1 year, weekly for first month, then monthly for 10 months, 90 min each N/A Significant:

  • Increased fruit and vegetable intake

  • Increased use of monosaturated cooking oils

Non-significant:

  • Total fat intake

  • Saturated fat intake

  • HbA1c

  • HDL

  • LDL

  • Triglyceride levels

 Non-significant:

  • Total per member per month expenditures

  • Per member per month inpatient expenses

  • Total per patient per month pharmacy expenses
Montoya, 2016 Adults with stage 4 chronic kidney disease Two outpatient nephrology clinics in FL 30 Mean age: not reported; 53% female, 47% male; 60% Caucasian, 23% African American, 10% Hispanic, 7% Other Chronic Care Model; 6 monthly sessions; 90–120 min each; n = 13 N/A Non-significant:

  • Blood pressure

  • Weight

  • BMI

  • Glomerular filtration rate

  • Creatinine

  • Potassium

  • Phosphorous

  • hemoglobin

 N/A
Scott, 2004 (See Coleman 2001) Significant:

  • Increased satisfaction with PCP, PCP’s unhurriedness, and overall quality of care

  • Increased satisfaction with talking to PCP about advance directives and education received from the pharmacist and nurse

Non-significant:

  • Perceived health status

 Non-significant:

  • Basic, household, and advanced ADLs

 Significant:

  • Fewer ED visits

  • Fewer hospital admissions

  • Fewer professional services

  • Lower costs for ED visits

Non-significant:

  • Clinic visits

  • Outpatient visits

  • SNF admissions

  • Home health visits

  • Hospital costs

  • Professional services costs

  • SNF costs

  • Home health costs

  • Health-plan termination costs

  • Total cost

a Abbreviations: ADA = American Diabetes Association; ADL = activities of daily living; BMI = body mass index; CHCC = Cooperative Health Care Clinic; CHW = community health worker; CP = Centering Pregnancy; CPP= Centering Pregnancy Plus; ED= emergency department; HbA1c= hemoglobin A1c levels; HDL= high-density lipoprotein cholesterol; HMO = health maintenance organization; LDL = low-density lipoprotein cholesterol; NICU= neonatal intensive care unit; PCP = primary care provider; SNF = skilled nursing facility; STI = sexually transmitted infection; VA-MEDIC = Veterans Affairs Multidisciplinary Education and Diabetes Intervention for Cardiac risk reduction; VA = Veterans Affairs; VA-MEDIC-D = Veterans Affairs Multidisciplinary Education and Diabetes Intervention for Cardiac risk reduction in Depression; VA-MEDIC-E = Veterans Affairs Multidisciplinary Education and Diabetes Intervention for Cardiac risk reduction, Extended. b Missing data if not specified in study.