Brown School, Washington University, St. Louis, MO, USA.
Am J Psychiatry. 2012 Aug;169(8):790-804. doi: 10.1176/appi.ajp.2012.11111616.
Collaborative chronic care models (CCMs) improve outcome in chronic medical illnesses and depression treated in primary care settings. The effect of such models across other treatment settings and mental health conditions has not been comprehensively assessed. The authors performed a systematic review and meta-analysis to assess the comparative effectiveness of CCMs for mental health conditions across disorders and treatment settings.
Randomized controlled trials comparing CCMs with other care conditions, published or in press by August 15, 2011, were identified in a literature search and through contact with investigators. CCMs were defined a priori as interventions with at least three of the six components of the Improving Chronic Illness Care initiative (patient self-management support, clinical information systems, delivery system redesign, decision support, organizational support, and community resource linkages). Articles were included if the CCM effect on mental health symptoms or mental quality of life was reported. Data extraction included analyses of these outcomes plus social role function, physical and overall quality of life, and costs. Meta-analyses included comparisons using unadjusted continuous measures.
Seventy-eight articles yielded 161 analyses from 57 trials (depression, N=40; bipolar disorder, N=4; anxiety disorders, N=3; multiple/other disorders, N=10). The meta-analysis indicated significant effects across disorders and care settings for depression as well as for mental and physical quality of life and social role function (Cohen's d values, 0.20-0.33). Total health care costs did not differ between CCMs and comparison models. A systematic review largely confirmed and extended these findings across conditions and outcome domains.
CCMs can improve mental and physical outcomes for individuals with mental disorders across a wide variety of care settings, and they provide a robust clinical and policy framework for care integration.
合作性慢性病管理模式（CCM）可改善初级保健环境中治疗的慢性内科疾病和抑郁症的结果。但是，尚未全面评估此类模式在其他治疗环境和心理健康状况下的效果。作者进行了一项系统评价和荟萃分析，以评估 CCM 在各种疾病和治疗环境下对心理健康状况的比较效果。
通过文献检索和与研究人员联系，确定了 2011 年 8 月 15 日之前发表或即将发表的比较 CCM 与其他护理条件的随机对照试验。CCM 被定义为具有改善慢性病护理计划的六个组成部分中的至少三个部分的干预措施（患者自我管理支持，临床信息系统，交付系统重新设计，决策支持，组织支持和社区资源联系）。如果报告了 CCM 对心理健康症状或心理健康生活质量的影响，则将文章包括在内。数据提取包括对这些结果以及社会角色功能，身体和整体生活质量以及成本的分析。荟萃分析包括使用未经调整的连续测量值进行比较。
78 篇文章从 57 项试验中得出了 161 项分析（抑郁症，N = 40；双相情感障碍，N = 4；焦虑症，N = 3；多种/其他疾病，N = 10）。荟萃分析表明，在各种疾病和护理环境中，抑郁以及心理健康和生活质量以及社会角色功能均存在显著影响（Cohen's d 值，0.20-0.33）。CCM 和比较模型之间的总医疗保健成本没有差异。系统评价在各种条件和结果领域中基本证实并扩展了这些发现。
CCM 可以改善各种护理环境中患有精神疾病的个体的心理和身体结果，并且为护理整合提供了强大的临床和政策框架。
