Nikitovic M, Brener S
Ont Health Technol Assess Ser. 2013 Sep 1;13(12):1-87. eCollection 2013.
As part of ongoing efforts to improve the Ontario health care system, a mega-analysis examining the optimization of chronic disease management in the community was conducted by Evidence Development and Standards, Health Quality Ontario (previously known as the Medical Advisory Secretariat [MAS]).
The purpose of this report was to identify health technologies previously evaluated by MAS that may be leveraged in efforts to optimize chronic disease management in the community.
The Ontario Health Technology Assessment Series and field evaluations conducted by MAS and its partners between January 1, 2006, and December 31, 2011.
Technologies related to at least 1 of 7 disease areas of interest (type 2 diabetes, coronary artery disease, atrial fibrillation, chronic obstructive pulmonary disease, congestive heart failure, stroke, and chronic wounds) or that may greatly impact health services utilization were reviewed. Only technologies with a moderate to high quality of evidence and associated with a clinically or statistically significant improvement in disease management were included. Technologies related to other topics in the mega-analysis on chronic disease management were excluded. Evidence-based analyses were reviewed, and outcomes of interest were extracted. Outcomes of interest included hospital utilization, mortality, health-related quality of life, disease-specific measures, and economic analysis measures.
Eleven analyses were included and summarized. Technologies fell into 3 categories: those with evidence for the cure of chronic disease, those with evidence for the prevention of chronic disease, and those with evidence for the management of chronic disease.
The impact on patient outcomes and hospitalization rates of new health technologies in chronic disease management is often overlooked. This analysis demonstrates that health technologies can reduce the burden of illness; improve patient outcomes; reduce resource utilization intensity; be cost-effective; and be a viable contributing factor to chronic disease management in the community.
People with chronic diseases rely on the health care system to help manage their illness. Hospital use can be costly, so community-based alternatives are often preferred. Research published in the Ontario Health Technology Assessment Series between 2006 and 2011 was reviewed to identify health technologies that have been effective or cost-effective in helping to manage chronic disease in the community. All technologies identified led to better patient outcomes and less use of health services. Most were also cost-effective. Two technologies that can cure chronic disease and 1 that can prevent chronic disease were found. Eight technologies that can help manage chronic disease were also found. Health technologies should be considered an important part of chronic disease management in the community.
作为安大略省医疗保健系统持续改进工作的一部分，安大略省卫生质量部（前身为医学咨询秘书处[MAS]）的循证发展与标准部门开展了一项大型分析，以研究社区慢性病管理的优化。
本报告旨在确定MAS之前评估过的卫生技术，这些技术可用于优化社区慢性病管理。
安大略省卫生技术评估系列以及MAS及其合作伙伴在2006年1月1日至2011年12月31日期间进行的实地评估。
对与7个感兴趣的疾病领域（2型糖尿病、冠状动脉疾病、心房颤动、慢性阻塞性肺疾病、充血性心力衰竭、中风和慢性伤口）中至少1个相关的技术，或可能对卫生服务利用产生重大影响的技术进行审查。仅纳入证据质量为中度至高且与疾病管理方面临床或统计学上显著改善相关的技术。排除了慢性病管理大型分析中与其他主题相关的技术。对循证分析进行审查，并提取感兴趣的结果。感兴趣的结果包括医院利用情况、死亡率、健康相关生活质量、疾病特异性指标以及经济分析指标。
纳入并总结了11项分析。技术分为3类：有治愈慢性病证据的技术、有预防慢性病证据的技术以及有管理慢性病证据的技术。
慢性病管理中新卫生技术对患者结局和住院率的影响常常被忽视。该分析表明，卫生技术可减轻疾病负担；改善患者结局；降低资源利用强度；具有成本效益；并且是社区慢性病管理的一个可行的促成因素。
慢性病患者依赖医疗保健系统来帮助管理他们的疾病。住院费用可能很高，因此通常更倾向于基于社区的替代方案。对200
