Dataset Information

Aspects of Multicomponent Integrated Care Promote Sustained Improvement in Surrogate Clinical Outcomes: A Systematic Review and Meta-analysis.

ABSTRACT:

Objective

The implementation of the Chronic Care Model (CCM) improves health care quality. We examined the sustained effectiveness of multicomponent integrated care in type 2 diabetes.

Research design and methods

We searched PubMed and Ovid MEDLINE (January 2000-August 2016) and identified randomized controlled trials comprising two or more quality improvement strategies from two or more domains (health system, health care providers, or patients) lasting ?12 months with one or more clinical outcomes. Two reviewers extracted data and appraised the reporting quality.

Results

In a meta-analysis of 181 trials (N = 135,112), random-effects modeling revealed pooled mean differences in HbA_1c of -0.28% (95% CI -0.35 to -0.21) (-3.1 mmol/mol [-3.9 to -2.3]), in systolic blood pressure (SBP) of -2.3 mmHg (-3.1 to -1.4), in diastolic blood pressure (DBP) of -1.1 mmHg (-1.5 to -0.6), and in LDL cholesterol (LDL-C) of -0.14 mmol/L (-0.21 to -0.07), with greater effects in patients with LDL-C ?3.4 mmol/L (-0.31 vs. -0.10 mmol/L for <3.4 mmol/L; P_difference = 0.013), studies from Asia (HbA_1c -0.51% vs. -0.23% for North America [-5.5 vs. -2.5 mmol/mol]; P_difference = 0.046), and studies lasting >12 months (SBP -3.4 vs. -1.4 mmHg, P_difference = 0.034; DBP -1.7 vs. -0.7 mmHg, P_difference = 0.047; LDL-C -0.21 vs. -0.07 mmol/L for 12-month studies, P_difference = 0.049). Patients with median age <60 years had greater HbA_1c reduction (-0.35% vs. -0.18% for ?60 years [-3.8 vs. -2.0 mmol/mol]; P_difference = 0.029). Team change, patient education/self-management, and improved patient-provider communication had the largest effect sizes (0.28-0.36% [3.0-3.9 mmol/mol]).

Conclusions

Despite the small effect size of multicomponent integrated care (in part attenuated by good background care), team-based care with better information flow may improve patient-provider communication and self-management in patients who are young, with suboptimal control, and in low-resource settings.

SUBMITTER: Lim LL

PROVIDER: S-EPMC5961399 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Aspects of Multicomponent Integrated Care Promote Sustained Improvement in Surrogate Clinical Outcomes: A Systematic Review and Meta-analysis.

Lim Lee Ling LL Lau Eric S H ESH Kong Alice P S APS Davies Melanie J MJ Levitt Naomi S NS Eliasson Björn B Aguilar-Salinas Carlos A CA Ning Guang G Seino Yutaka Y So Wing Yee WY McGill Margaret M Ogle Graham D GD Orchard Trevor J TJ Clarke Philip P Holman Rury R RR Gregg Edward W EW Gagliardino Juan José JJ Chan Juliana C N JCN

Diabetes care 20180601 6

<h4>Objective</h4>The implementation of the Chronic Care Model (CCM) improves health care quality. We examined the sustained effectiveness of multicomponent integrated care in type 2 diabetes.<h4>Research design and methods</h4>We searched PubMed and Ovid MEDLINE (January 2000-August 2016) and identified randomized controlled trials comprising two or more quality improvement strategies from two or more domains (health system, health care providers, or patients) lasting ≥12 months with one or mor ...[more]

PMID: 29784698

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Project description:BackgroundAchievement of diabetes care goals is suboptimal globally. Diabetes-focused quality improvement (QI) is effective but remains untested in South Asia.ObjectiveTo compare the effect of a multicomponent QI strategy versus usual care on cardiometabolic profiles in patients with poorly controlled diabetes.DesignParallel, open-label, pragmatic randomized, controlled trial. (ClinicalTrials.gov: NCT01212328).SettingDiabetes clinics in India and Pakistan.Patients1146 patients (575 in the intervention group and 571 in the usual care group) with type 2 diabetes and poor cardiometabolic profiles (glycated hemoglobin [HbA1c] level ≥8% plus systolic blood pressure [BP] ≥140 mm Hg and/or low-density lipoprotein cholesterol [LDLc] level ≥130 mg/dL).InterventionMulticomponent QI strategy comprising nonphysician care coordinators and decision-support electronic health records.MeasurementsProportions achieving HbA1c level less than 7% plus BP less than 130/80 mm Hg and/or LDLc level less than 100 mg/dL (primary outcome); mean risk factor reductions, health-related quality of life (HRQL), and treatment satisfaction (secondary outcomes).ResultsBaseline characteristics were similar between groups. Median diabetes duration was 7.0 years; 6.8% and 39.4% of participants had preexisting cardiovascular and microvascular disease, respectively; mean HbA1c level was 9.9%; mean BP was 143.3/81.7 mm Hg; and mean LDLc level was 122.4 mg/dL. Over a median of 28 months, a greater percentage of intervention participants achieved the primary outcome (18.2% vs. 8.1%; relative risk, 2.24 [95% CI, 1.71 to 2.92]). Compared with usual care, intervention participants achieved larger reductions in HbA1c level (-0.50% [CI, -0.69% to -0.32%]), systolic BP (-4.04 mm Hg [CI, -5.85 to -2.22 mm Hg]), diastolic BP (-2.03 mm Hg [CI, -3.00 to -1.05 mm Hg]), and LDLc level (-7.86 mg/dL [CI, -10.90 to -4.81 mg/dL]) and reported higher HRQL and treatment satisfaction.LimitationFindings were confined to urban specialist diabetes clinics.ConclusionMulticomponent QI improves achievement of diabetes care goals, even in resource-challenged clinics.Primary funding sourceNational Heart, Lung, and Blood Institute and UnitedHealth Group.

Project description:IntroductionData from the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) registry suggests that reliable collection of patient-reported outcomes (PROs) varies across sites. The objective of this study was to better understand the practices of collecting PROs at PR-COIN sites.MethodsA REDCap survey was sent to the lead representative for each PR-COIN site. Registry data were analyzed to better understand the completion rates of PROs. Interviews of physician leaders of high performing sites were conducted by videoconference, audiotranscribed and themes were summarized. Quantitative data were analyzed using descriptive statistics and qualitative data were thematically analyzed.ResultsAll 23 PR-COIN sites responded to the survey. PROs were collected by 21/23 (91%) sites. Arthritis-related pain intensity, morning stiffness, and physical function were the top three collected PROs ( Supplementary 3 and 4). PROs were collected using paper, electronically or in combination, with most sites collecting PROs only on paper. PROs were manually scored at most sites. Among sites with electronic PRO collection, 42% did not have automatic transfer of scores into the electronic medical record. Facilitators to successful collection of PROs included availability of staff, training, and culture. Barriers to PRO collection cited were limited time, lack of infrastructure, and lack of staff. Completion rates of PROs in the registry in top 4 performing centers for morning stiffness was 100%, overall well-being and pain intensity scores ranged from 93%-98%, and for physical function 69%-94%. Interviews with physician leaders indicated that their site overcame barriers through: integration of PRO collection into workflow, gaining buy-in of stakeholders (clinicians and patients), and automating PRO collection. Interviewees endorsed automation of data collection (e.g., self-completion on tablets) and automated transfer to electronic medical record (EMR) as key components enabling reliable PRO collection.ConclusionsThrough understanding our current ability to systematically collect PROs across all sites in PR-COIN and exploring successful implementation of PRO collection both within and outside our learning health network, we share lessons learned and identify the most influential factors for successful PRO collection in pediatric rheumatology.

Dataset Information

Aspects of Multicomponent Integrated Care Promote Sustained Improvement in Surrogate Clinical Outcomes: A Systematic Review and Meta-analysis.

Objective

Research design and methods

Results

Conclusions

Publications

Aspects of Multicomponent Integrated Care Promote Sustained Improvement in Surrogate Clinical Outcomes: A Systematic Review and Meta-analysis.

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