Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Department of Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada.
BMJ Open. 2017 Sep 3;7(9):e017701. doi: 10.1136/bmjopen-2017-017701.
A common reason for frequent use of healthcare services is the complex healthcare needs of individuals suffering from multiple chronic conditions, especially in combination with mental health comorbidities and/or social vulnerability. Frequent users (FUs) of healthcare services are more at risk for disability, loss of quality of life and mortality. Case management (CM) is a promising intervention to improve care integration for FU and to reduce healthcare costs. This review aims to develop a middle-range theory explaining how CM in primary care improves outcomes among FU with chronic conditions, for what types of FU and in what circumstances.
A realist synthesis (RS) will be conducted between March 2017 and March 2018 to explore the causal mechanisms that underlie CM and how contextual factors influence the link between these causal mechanisms and outcomes. According to RS methodology, five steps will be followed: (1) focusing the scope of the RS; (2) searching for the evidence; (3) appraising the quality of evidence; (4) extracting the data; and (5) synthesising the evidence. Patterns in context-mechanism-outcomes (CMOs) configurations will be identified, within and across identified studies. Analysis of CMO configurations will help confirm, refute, modify or add to the components of our initial rough theory and ultimately produce a refined theory explaining how and why CM interventions in primary care works, in which contexts and for which FU with chronic conditions.
Research ethics is not required for this review, but publication guidelines on RS will be followed. Based on the review findings, we will develop and disseminate messages tailored to various relevant stakeholder groups. These messages will allow the development of material that provides guidance on the design and the implementation of CM in health organisations.
Prospero CRD42017057753.
频繁使用医疗保健服务的一个常见原因是患有多种慢性疾病的个体的复杂医疗需求，尤其是与心理健康共病和/或社会脆弱性相结合时。医疗保健服务的频繁使用者（FU）更有可能残疾、丧失生活质量和死亡。病例管理（CM）是一种有前途的干预措施，可以改善 FU 的护理整合，并降低医疗保健成本。本综述旨在制定一个中程理论，解释初级保健中的 CM 如何改善患有慢性疾病的 FU 的结局，以及在何种情况下为哪些类型的 FU 改善结局。
2017 年 3 月至 2018 年 3 月期间，将进行一项真实主义综合（RS）研究，以探索构成 CM 的因果机制以及情境因素如何影响这些因果机制与结局之间的联系。根据 RS 方法，将遵循五个步骤：（1）集中 RS 的范围；（2）搜索证据；（3）评估证据的质量；（4）提取数据；（5）综合证据。将在已确定的研究内和跨研究确定 CMO 配置模式。对 CMO 配置的分析将有助于确认、反驳、修改或添加我们初始粗略理论的组成部分，并最终产生一个解释初级保健中的 CM 干预如何以及为何起作用、在何种情况下以及针对哪些患有慢性疾病的 FU 的精制理论。
本综述不需要研究伦理，但将遵循 RS 研究的出版指南。根据审查结果，我们将针对各种相关利益相关者群体制定和传播有针对性的信息。这些信息将允许开发针对卫生组织中 CM 设计和实施的指导材料。
Prospero CRD42017057753。
