Integrated care programmes for adults with chronic conditions: a meta-review

Abstract

ObjectiveTo review systematic reviews and meta-analyses of integrated care programmes in chronically ill patients, with a focus on methodological quality, elements of integration assessed and effects reported.DesignMeta-review of systematic reviews and meta-analyses identified in Medline (1946–March 2012), Embase (1980–March 2012), CINHAL (1981–March 2012) and the Cochrane Library of Systematic Reviews (issue 1, 2012).Main Outcome MeasuresMethodological quality assessed by the 11-item Assessment of Multiple Systematic Reviews (AMSTAR) checklist; elements of integration assessed using a published list of 10 key principles of integration; effects on patient-centred outcomes, process quality, use of healthcare and costs.ResultsTwenty-seven systematic reviews were identified; conditions included chronic heart failure (CHF; 12 reviews), diabetes mellitus (DM; seven reviews), chronic obstructive pulmonary disease (COPD; seven reviews) and asthma (five reviews). The median number of AMSTAR checklist items met was five: few reviewers searched for unpublished literature or described the primary studies and interventions in detail. Most reviews covered comprehensive services across the care continuum or standardization of care through inter-professional teams, but organizational culture, governance structure or financial management were rarely assessed. A majority of reviews found beneficial effects of integration, including reduced hospital admissions and re-admissions (in CHF and DM), improved adherence to treatment guidelines (DM, COPD and asthma) or quality of life (DM). Few reviews showed reductions in costs.ConclusionsSystematic reviews of integrated care programmes were of mixed quality, assessed only some components of integration of care, and showed consistent benefits for some outcomes but not others.

Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness?

“…Ouwens et al (2005) conducted a metareview of 13 studies that focussed on identifying the characteristics of integrated care that were important in improving the care of chronically ill people, as well as their effectiveness. Martínez-González et al (2014), building on the work by Ouwens et al (2005), conducted a meta-review seeking to identify the principles that facilitate high-quality integrated care.…”

A Respiratory Therapist Disease Management Program for Subjects Hospitalized With COPD

“…The median (interquartile range) duration of hospitalization for a COPD exacerbation was less for subjects in the intervention group (5 [3][4][5][6][7][8][9][10][11] d vs 8 [4 -18.5] d, P ϭ .045). Total in-patient hospital days and ICU days due to COPD exacerbations were significantly less for the intervention group (Table 5).…”

“…Disease management can be broadly defined as a comprehensive strategy for improving overall health status and reducing healthcare costs in chronic conditions. 5 These programs are often conducted by physician extenders and may include education about the underlying disease, optimization of evidence-based medications, support from case managers, and institution of self-management principles. 6 …”

E-Care Project: A Promising E-Platform for Optimizing Management of Chronic Heart Failure and Other Chronic Diseases

“…[2][3][4][5][6] Advances in telecommunication technologies have created new opportunities to provide telemedical care as complementary treatment to the medical management of HF patients. Meta-analyses have suggested that telemedicine can reduce morbidity and mortality in patients with these types of disorder.…”

“…In reviews assessing these methods, telemedicine approaches range from computerbased support systems to ones founded on structured telephone support, or even to programs led by nurses and physicians. 2,6 It is thus difficult to have a definitive opinion based on what we know now on whether or not telemedicine has a significant role to play in HF management.…”