Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2014 Oct;26(5):561-70.
doi: 10.1093/intqhc/mzu071. Epub 2014 Aug 9.

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

Nahara Anani Martínez-González  1 , Peter Berchtold  2 , Klara Ullman  3 , André Busato  3 , Matthias Egger  3
Affiliations
Meta-Analysis

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

Nahara Anani Martínez-González et al. Int J Qual Health Care. 2014 Oct.

Abstract

Objective: To 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.

Design: Meta-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 measures: Methodological 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.

Results: Twenty-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 The median number of AMSTAR checklist items met was five: few reviewers searched for unpublished literature or described the primary studies and interventions in detail.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.

Conclusions: Systematic 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.

Keywords: chronic conditions; health services research; integrated healthcare; quality improvement; systematic review.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study selection process.
Figure 2
Figure 2
Proportion of systematic reviews that addressed each of the methodological quality items of the AMSTAR tool; based on 27 included systematic reviews.
See this image and copyright information in PMC

References

    1. Leape L, Berwick D, Clancy C, et al. Transforming healthcare: a safety imperative. Qual Saf Health Care. 2009;18:424–8. - PubMed
    1. Glouberman S, Mintzberg H. Managing the care of health and the cure of disease—Part I: differentiation. Health Care Manage Rev. 2001;26:56–69. discussion 87–9. - PubMed
    1. Strandberg-Larsen M, Krasnik A. Measurement of integrated healthcare delivery: a systematic review of methods and future research directions. Int J Integr Care. 2009;9:e01. - PMC - PubMed
    1. Suter E, Oelke ND, Adair CE, et al. Health Systems Integration. Definitions, Processes & Impact: A Research Synthesis. Ottawa: Canadian Institutes of Health Research; 2007.
    1. Kodner DL. All together now: a conceptual exploration of integrated care. Healthc Q. 2009;13(Spec No):6–15. - PubMed

Publication types