Integrated care programmes for adults with chronic conditions: a meta-review
Open accessAbstract
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 The median number of AMSTAR checklist items met was five: few reviewers searched for unpublished literature or described the primary studies and interventions in detail.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.
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The overall quality of these intervention studies is moderately strong.
“The overall quality of these intervention studies is moderately strong 37 .”
From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [37]
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- Authors
- Martínez-González, N. A., Berchtold, P., Ullman, K., Busato, A., & Egger, M.
- Affiliations
- University of Bern (CH)
- Venue
- International Journal for Quality in Health Care
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-08-09
- Volume
- 26
- Issue
- 5
- Pages
- 561-570
- ISSN
- 1353-4505 (ISSN-L)
- 1464-3677
- PMC
- PMC4195469
- OpenAlex
- W2145187093
- Cited by
- 253
- References
- 45
- Citations by year
- 2026: 10 · 2025: 19 · 2024: 14 · 2023: 9 · 2022: 26 · 2021: 20 · 2020: 20 · 2019: 37 · 2018: 37 · 2017: 23 · 2016: 24 · 2015: 13 · 2012: 1
- FWCI
- 2.67
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- International Journal for Quality in Health Care (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- reroDoc Digital Library (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by-nc-nd)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Bundesamt für Gesundheit
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Health Professions › General Health Professions › Interprofessional Education and Collaboration
- Keywords
- integrated care, chronic disease, methodological quality of systematic reviews, patient-centered outcomes, hospital readmission, guideline adherence, health care costs, chronic heart failure, diabetes mellitus, chronic obstructive pulmonary disease, asthma, quality of life
- MeSH terms
- Chronic Disease, Comprehensive Health Care, Continuity of Patient Care, Hospitalization, Humans, Patient Care Team, Quality of Health Care, Quality of Life, Organizational Culture, Practice Guidelines as Topic, Systems Integration, Guideline Adherence
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