Systematic Reviews

Ouwens M, Wollersheim H, Hermens R, Hulscher M, Grol R. Integrated care programmes for chronically ill patients: a review of systematic reviews. Int J Qual Health Care 2005; 17(2):141-6. [Link]

A review of systematic reviews demonstrates that integrated care programs generally have positive outcomes. The most commonly used components of integrated care programs include: self-management support, patient education, case management, multidisciplinary patient care team, and clinical feedback/reminders/education. Authors caution that inconsistent definitions of interventions and outcomes are prevalent throughout the literature and, if ignored, can lead to inappropriate conclusions about the effectiveness of programs in meta-analyses.
 
Gilbody S, Whitty P, Grimshaw J, Thomas R. Educational and organizational interventions to improve the management of depression in primary care: a systematic review. JAMA 2003; 289(23):3145-51. [Link]
 
One of two reviews of depression treatment in primary care finds that complex interventions using clinician education, enhanced nurse case management, and greater integration between primary and specialty care are effective in improving patient outcomes. Less complex interventions like provider education alone are not as likely to be effective.
 
Badamgarav E, Weingarten SR, Henning JM et al. Effectiveness of disease management programs in depression: a systematic review. Am J Psychiatry 2003; 160(12):2080-90. [Link]
 
Badamgarav and colleagues conducted systematic evaluation of disease management. Lack of a clear definition of “disease management” makes interpreting the findings difficult, but in general they found an improvement in patient satisfaction, adequacy of prescribed treatment, and other quality of care markers. They also found increases in costs associated with hospitalization and treatment costs among the intervention groups as compared to controls.
 
Walsh JM, McDonald KM, Shojania KG et al. Quality improvement strategies for hypertension management: a systematic review. Med Care 2006; 44(7):646-57. [Link]
 
A review of quality improvement strategies in hypertension finds that interventions that include team care are associated with the greatest improvement in blood pressure outcomes. Here, team care is defined as the “assignment of some responsibilities to a health professional other than the patient's physician.” Other strategies that proved effective include patient education and self-management support.
 
Glasgow RE, Hiss RG, Anderson RM et al. Report of the health care delivery work group: behavioral research related to the establishment of a chronic disease model for diabetes care. Diabetes Care 2001; 24(1):124-30. [Link]
 
Glasgow and colleagues published a literature review and expert recommendations for future research around diabetes care as part of the Health Care Delivery Work Group. They find that the continued focus on acute illness, rather than proactive chronic care management, is the cause for poor-quality diabetes care processes and outcomes. They cite articles showing that self-management support, improved patient-provider communication, and collaborative goal setting are linked to improved behavioral, biological, and quality of life outcomes. They also cite that a population focus, inclusion of clinician prompts and reminders, and a quality clinical information systems that supports disease registries are helpful tools to improve care.
 
Renders CM, Valk GD, Griffin SJ, Wagner EH, Eijk Van JT, Assendelft WJ. Interventions to improve the  management of diabetes in primary care, outpatient, and community settings: a systematic review. Diabetes Care 2001; 24(10):1821-33. [Link]
 
A second systematic review of diabetes shows that multifaceted interventions that “facilitate structured and regular review of patients were effective in improving the process of care.” Renders et al finds that studies rarely assess outcomes. Like the studies above, they find that clinician education with performance feedback and use of care teams seemed to improve care.
 
Shojania KG, Ranji SR, McDonald KM et al. Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA 2006; 296(4):427-40. [Link]
 
A recent Cochrane review of diabetes care finds that in 58 papers with 66 comparisons, quality improvement initiatives that used team changes and those that use case management with the ability to influence physicians’ prescribing patterns showed the largest difference in post intervention HbA1c scores.