Transforming chronic care: a systematic review of the evidence

doi:10.1016/j.ebcm.2005.03.011

Evidence-based Cardiovascular Medicine

Volume 9, Issue 2, June 2005, Pages 91-94

https://doi.org/10.1016/j.ebcm.2005.03.011 Get rights and content

Section snippets

Search strategy

One reviewer searched Medline, Embase, Eric, the Science Citation Index, the Cochrane Controlled Trials Register, DARE, NHS Health Technology Assessment and Economic Assessment databases, PsychLit, the WHO library, reference lists of identified articles and reviews, and the websites of relevant agencies for information available in English as at 1 January 2005. Experts in the field were contacted and relevant journals were hand searched for additional studies.

Published and unpublished

Broad programmes

We found 13 systematic reviews, three additional randomised trials, and seven other high quality studies about the effects of broad care management programmes.⁴

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There is some evidence that multifaceted managed care programmes improve the quality of care for people with long-term conditions, but it remains uncertain which components of these programmes are most effective.
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There is some evidence that broad managed care programmes tend to improve clinical outcomes, but this evidence is not of the

Care pathways

Care pathways are guidelines or protocols to help people move through different parts of the healthcare system. There was inconsistent information about the benefits of care pathways and clinical guidelines for people with long-term conditions from four systematic reviews, 12 additional randomised trials, and four other studies.⁴

Case management

‘Case management’ is when a professional or team of professionals organise and follow-up a patient's care, even if patients are receiving care from many different

Involving people in decision-making

We included six systematic reviews, 16 additional randomised trials, and 10 other high quality studies about patient involvement in decision-making in chronic care.⁴ Involving people with long-term conditions in decision-making may improve their satisfaction with care, but some people are more likely to want to be involved than others. There is no clear evidence about the ‘best way’ to involve people with long-term conditions in decision-making and planning. There is little evidence about the

Summary

A review of 560 systematic reviews, randomised trials, and other studies suggests that initiatives to improve the care of people with long-term conditions can enhance satisfaction with care, quality of life, and in some cases, use of health services.

There is evidence to support the following initiatives:

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Broad chronic care management models
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Integrated community and hospital care
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Greater reliance on primary care
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Identifying people at greatest risk of complications and hospitalisation
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Involving people

Acknowledgements

This evidence appraisal was funded by the Transforming Chronic Care Programme and the Surrey and Sussex PCT Alliance, United Kingdom. The review was published by the University of Birmingham Health Services Management Centre.

References

1. Are Disease Management Programmes (DMPs) Effective in Improving Quality of Care for People with Chronic Conditions? WHO Regional Office for Europe's Health Evidence Network, 2003.

2. Innovative Care for Chronic Conditions. Building Blocks for Action. WHO, 2002.

3. Bodenheimer T. Interventions to improve chronic illness care: evaluating their effectiveness. Dis Manag 2003;6(2):63–71.

4. A copy of the full review, along with all references is available at www.hsmc.bham.ac.uk/news/Transforming

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EditorialTransforming chronic care: a systematic review of the evidence