Centre for Evidence-based Health Care, Division Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.
BMC Health Serv Res. 2023 Aug 23;23(1):894. doi: 10.1186/s12913-023-09894-7.
The prevalence of multi-morbidity is increasing globally. Integrated models of care present a potential intervention to improve patient and health system outcomes. However, the intervention components and concepts within different models of care vary widely and their effectiveness remains unclear. We aimed to describe and map the definitions, characteristics, components, and reported effects of integrated models of care in systematic reviews (SRs).
We conducted a scoping review of SRs according to pre-specified methods (PROSPERO 2019 CRD42019119265). Eligible SRs assessed integrated models of care at primary health care level for adults and children with multi-morbidity. We searched in PubMed (MEDLINE), Embase, Cochrane Database of Systematic Reviews, Epistemonikos, and Health Systems Evidence up to 3 May 2022. Two authors independently assessed eligibility of SRs and extracted data. We identified and described common components of integrated care across SRs. We extracted findings of the SRs as presented in the conclusions and reported on these verbatim.
We included 22 SRs, examining data from randomised controlled trials and observational studies conducted across the world. Definitions and descriptions of models of integrated care varied considerably. However, across SRs, we identified and described six common components of integrated care: (1) chronic conditions addressed, (2) where services were provided, (3) the type of services provided, (4) healthcare professionals involved in care, (5) coordination and organisation of care and (6) patient involvement in care. We observed differences in the components of integrated care according to the income setting of the included studies. Some SRs reported that integrated care was beneficial for health and process outcomes, while others found no difference in effect when comparing integrated care to other models of care.
Integrated models of care were heterogeneous within and across SRs. Information that allows the identification of effective components of integrated care was lacking. Detailed, standardised and transparent reporting of the intervention components and their effectiveness on health and process outcomes is needed.
全球范围内，多病共存的患病率正在上升。综合护理模式是一种改善患者和卫生系统结果的潜在干预措施。然而，不同护理模式中的干预措施组成部分和概念差异很大，其效果仍不清楚。我们旨在描述和绘制系统评价（SRs）中综合护理模式的定义、特征、组成部分和报告效果。
我们根据预先确定的方法（PROSPERO 2019 CRD42019119265）对 SRs 进行了范围界定审查。合格的 SRs 评估了初级卫生保健水平下患有多种疾病的成年人和儿童的综合护理模式。我们在 5 月 3 日之前在 PubMed（MEDLINE）、Embase、Cochrane 系统评价数据库、Epistemonikos 和卫生系统证据中进行了搜索。两名作者独立评估了 SRs 的资格并提取了数据。我们确定并描述了跨 SR 综合护理的常见组成部分。我们提取了 SRs 结论中呈现的研究结果，并逐字报告。
我们纳入了 22 项 SRs，研究数据来自世界各地的随机对照试验和观察性研究。综合护理模式的定义和描述差异很大。然而，在 SRs 中，我们确定并描述了综合护理的六个常见组成部分：（1）处理的慢性疾病，（2）服务提供的地点，（3）提供的服务类型，（4）参与护理的医疗保健专业人员，（5）护理的协调和组织，（6）患者参与护理。我们观察到，根据纳入研究的收入情况，综合护理模式的组成部分存在差异。一些 SRs 报告说，综合护理对健康和过程结果有益，而另一些 SRs 则发现综合护理与其他护理模式相比，在效果上没有差异。
SRs 内和跨 SRs 的综合护理模式存在异质性。缺乏有关综合护理有效组成部分的信息。需要详细、标准化和透明地报告干预措施组成部分及其对健康和过程结果的影响。
