Group Medical Care: A Systematic Review of Health Service Performance.

Group care models, in which patients with similar health conditions receive medical services in a shared appointment, have increasingly been adopted in a variety of health care settings. Applying the Triple Aim framework, we examined the potential of group medical care to optimize health system performance through improved patient experience, better health outcomes, and the reduced cost of health care. A systematic review of English language articles was conducted using the Cochrane Controlled Trials Register (CENTRAL), MEDLINE/PubMed, Scopus, and Embase. Studies based on data from randomized control trials (RCTs) conducted in the US and analyzed using an intent-to-treat approach to test the effect of group visits versus standard individual care on at least one Triple Aim domain were included. Thirty-one studies met the inclusion criteria. These studies focused on pregnancy (n = 9), diabetes (n = 15), and other chronic health conditions (n = 7). Compared with individual care, group visits have the potential to improve patient experience, health outcomes, and costs for a diversity of health conditions. Although findings varied between studies, no adverse effects were associated with group health care delivery in these randomized controlled trials. Group care models may contribute to quality improvements, better health outcomes, and lower costs for select health conditions.

Application of the Social Vulnerability Index for Identifying Teen Pregnancy Intervention Need in the United States.

Objectives Originally developed to assess emergency preparedness, evidence suggests the Social Vulnerability Index (SVI) may also be useful to investigate multilevel environmental and social influences on health risk behaviors and outcomes. This ecological study explores the application of the SVI as a predictor of teen pregnancy rates across counties in the United States (U.S.) and identifies areas with greatest need for community-based interventions. Methods County-level SVI and teen birth rate data were obtained from the Centers for Disease Control and Prevention. Regression analysis was conducted to examine associations between teen birth rates and social vulnerability, geographic region, and the four themes which compromise the index: socioeconomic status, household composition, minority status, and housing. Dot maps of teen birth rates and SVI by quartiles were used to examine spatial distribution across counties. Results Each increase in SVI quartile was associated with an additional 11.5 births per 1000 females ages 15-19. Higher social vulnerability was significantly associated with higher teen birth rates to varying degrees across the U.S., with largest effect sizes observed in East South Central (ß = 62.56; SE = 6.28; p < 0.001) and West South Central (ß = 66.75; SE = 5.33; p < 0.001) Census divisions. Among index themes, socioeconomic status (ß = 25.56; SE = 1.16; p < 0.001), household composition (ß = 23.49; SE = 1.00; p < 0.001), and minority/language status (ß = 10.99; SE = 0.83; p < 0.001) were positively associated with teen birth. No association was observed with housing/transportation. Conclusions The SVI offers a novel tool for identifying at-risk populations most in need of resources and guiding community-based teen pregnancy interventions across the U.S.