Comprehensive care programs for patients with multiple chronic conditions

A systematic literature review

Simone R. de Bruin*, Nathalie Versnel, Lidwien C. Lemmens, Claudia C. M. Molema, Francois G. Schellevis, Giel Nijpels, C.A. Baan

*Corresponding author for this work

Research output: Contribution to journalReview articleScientificpeer-review

Abstract

Objective: To provide insight into the characteristics of comprehensive care programs for patients with multiple chronic conditions and their impact on patients, informal caregivers, and professional caregivers.

Methods: Systematic literature search in multiple electronic databases for English language papers published between January 1995 and January 2011, supplemented by reference tracking and a manual search on the internet. Wagner's chronic care model (CCM) was used to define comprehensive care. After inclusion, the methodological quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions.

Results: Forty-two publications were selected describing thirty-three studies evaluating twenty-eight comprehensive care programs for multimorbid patients. Programs varied in the target patient groups, implementation settings, number of included interventions, and number of CCM components to which these interventions related. Moderate evidence was found for a beneficial effect of comprehensive care on inpatient healthcare utilization and healthcare costs, health behavior of patients, perceived quality of care, and satisfaction of patients and caregivers. Insufficient evidence was found for a beneficial effect of comprehensive care on health-related quality of life in terms of mental functioning, medication use, and outpatient healthcare utilization and healthcare costs. No evidence was found for a beneficial effect of comprehensive care on cognitive functioning, depressive symptoms, functional status, mortality, quality of life in terms of physical functioning, and caregiver burden.

Conclusion: Because of the heterogeneity of comprehensive care programs, it is as yet too early to draw firm conclusions regarding their effectiveness. More rigorous evaluation studies are necessary to determine what constitutes best care for the increasing number of people with multiple chronic conditions. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)108-145
Number of pages38
JournalHealth Policy
Volume107
Issue number2-3
DOIs
Publication statusPublished - Oct 2012
Externally publishedYes

Keywords

  • Chronic care
  • Comprehensive care
  • Effectiveness
  • Frailty
  • Multimorbidity
  • Integrated care
  • RANDOMIZED CONTROLLED-TRIAL
  • OF-THE-LITERATURE
  • OBSTRUCTIVE PULMONARY-DISEASE
  • SELF-MANAGEMENT PROGRAM
  • CHRONIC ILLNESS CARE
  • FRAIL OLDER-ADULTS
  • GUIDED CARE
  • HEALTH-CARE
  • HEART-FAILURE
  • GERIATRIC EVALUATION

Cite this

de Bruin, S. R., Versnel, N., Lemmens, L. C., Molema, C. C. M., Schellevis, F. G., Nijpels, G., & Baan, C. A. (2012). Comprehensive care programs for patients with multiple chronic conditions: A systematic literature review. Health Policy, 107(2-3), 108-145. https://doi.org/10.1016/j.healthpo1.2012.06.006
de Bruin, Simone R. ; Versnel, Nathalie ; Lemmens, Lidwien C. ; Molema, Claudia C. M. ; Schellevis, Francois G. ; Nijpels, Giel ; Baan, C.A. / Comprehensive care programs for patients with multiple chronic conditions : A systematic literature review. In: Health Policy. 2012 ; Vol. 107, No. 2-3. pp. 108-145.
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abstract = "Objective: To provide insight into the characteristics of comprehensive care programs for patients with multiple chronic conditions and their impact on patients, informal caregivers, and professional caregivers.Methods: Systematic literature search in multiple electronic databases for English language papers published between January 1995 and January 2011, supplemented by reference tracking and a manual search on the internet. Wagner's chronic care model (CCM) was used to define comprehensive care. After inclusion, the methodological quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions.Results: Forty-two publications were selected describing thirty-three studies evaluating twenty-eight comprehensive care programs for multimorbid patients. Programs varied in the target patient groups, implementation settings, number of included interventions, and number of CCM components to which these interventions related. Moderate evidence was found for a beneficial effect of comprehensive care on inpatient healthcare utilization and healthcare costs, health behavior of patients, perceived quality of care, and satisfaction of patients and caregivers. Insufficient evidence was found for a beneficial effect of comprehensive care on health-related quality of life in terms of mental functioning, medication use, and outpatient healthcare utilization and healthcare costs. No evidence was found for a beneficial effect of comprehensive care on cognitive functioning, depressive symptoms, functional status, mortality, quality of life in terms of physical functioning, and caregiver burden.Conclusion: Because of the heterogeneity of comprehensive care programs, it is as yet too early to draw firm conclusions regarding their effectiveness. More rigorous evaluation studies are necessary to determine what constitutes best care for the increasing number of people with multiple chronic conditions. (C) 2012 Elsevier Ireland Ltd. All rights reserved.",
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de Bruin, SR, Versnel, N, Lemmens, LC, Molema, CCM, Schellevis, FG, Nijpels, G & Baan, CA 2012, 'Comprehensive care programs for patients with multiple chronic conditions: A systematic literature review', Health Policy, vol. 107, no. 2-3, pp. 108-145. https://doi.org/10.1016/j.healthpo1.2012.06.006

Comprehensive care programs for patients with multiple chronic conditions : A systematic literature review. / de Bruin, Simone R.; Versnel, Nathalie; Lemmens, Lidwien C.; Molema, Claudia C. M.; Schellevis, Francois G.; Nijpels, Giel; Baan, C.A.

In: Health Policy, Vol. 107, No. 2-3, 10.2012, p. 108-145.

Research output: Contribution to journalReview articleScientificpeer-review

TY - JOUR

T1 - Comprehensive care programs for patients with multiple chronic conditions

T2 - A systematic literature review

AU - de Bruin, Simone R.

AU - Versnel, Nathalie

AU - Lemmens, Lidwien C.

AU - Molema, Claudia C. M.

AU - Schellevis, Francois G.

AU - Nijpels, Giel

AU - Baan, C.A.

PY - 2012/10

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N2 - Objective: To provide insight into the characteristics of comprehensive care programs for patients with multiple chronic conditions and their impact on patients, informal caregivers, and professional caregivers.Methods: Systematic literature search in multiple electronic databases for English language papers published between January 1995 and January 2011, supplemented by reference tracking and a manual search on the internet. Wagner's chronic care model (CCM) was used to define comprehensive care. After inclusion, the methodological quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions.Results: Forty-two publications were selected describing thirty-three studies evaluating twenty-eight comprehensive care programs for multimorbid patients. Programs varied in the target patient groups, implementation settings, number of included interventions, and number of CCM components to which these interventions related. Moderate evidence was found for a beneficial effect of comprehensive care on inpatient healthcare utilization and healthcare costs, health behavior of patients, perceived quality of care, and satisfaction of patients and caregivers. Insufficient evidence was found for a beneficial effect of comprehensive care on health-related quality of life in terms of mental functioning, medication use, and outpatient healthcare utilization and healthcare costs. No evidence was found for a beneficial effect of comprehensive care on cognitive functioning, depressive symptoms, functional status, mortality, quality of life in terms of physical functioning, and caregiver burden.Conclusion: Because of the heterogeneity of comprehensive care programs, it is as yet too early to draw firm conclusions regarding their effectiveness. More rigorous evaluation studies are necessary to determine what constitutes best care for the increasing number of people with multiple chronic conditions. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

AB - Objective: To provide insight into the characteristics of comprehensive care programs for patients with multiple chronic conditions and their impact on patients, informal caregivers, and professional caregivers.Methods: Systematic literature search in multiple electronic databases for English language papers published between January 1995 and January 2011, supplemented by reference tracking and a manual search on the internet. Wagner's chronic care model (CCM) was used to define comprehensive care. After inclusion, the methodological quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions.Results: Forty-two publications were selected describing thirty-three studies evaluating twenty-eight comprehensive care programs for multimorbid patients. Programs varied in the target patient groups, implementation settings, number of included interventions, and number of CCM components to which these interventions related. Moderate evidence was found for a beneficial effect of comprehensive care on inpatient healthcare utilization and healthcare costs, health behavior of patients, perceived quality of care, and satisfaction of patients and caregivers. Insufficient evidence was found for a beneficial effect of comprehensive care on health-related quality of life in terms of mental functioning, medication use, and outpatient healthcare utilization and healthcare costs. No evidence was found for a beneficial effect of comprehensive care on cognitive functioning, depressive symptoms, functional status, mortality, quality of life in terms of physical functioning, and caregiver burden.Conclusion: Because of the heterogeneity of comprehensive care programs, it is as yet too early to draw firm conclusions regarding their effectiveness. More rigorous evaluation studies are necessary to determine what constitutes best care for the increasing number of people with multiple chronic conditions. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

KW - Chronic care

KW - Comprehensive care

KW - Effectiveness

KW - Frailty

KW - Multimorbidity

KW - Integrated care

KW - RANDOMIZED CONTROLLED-TRIAL

KW - OF-THE-LITERATURE

KW - OBSTRUCTIVE PULMONARY-DISEASE

KW - SELF-MANAGEMENT PROGRAM

KW - CHRONIC ILLNESS CARE

KW - FRAIL OLDER-ADULTS

KW - GUIDED CARE

KW - HEALTH-CARE

KW - HEART-FAILURE

KW - GERIATRIC EVALUATION

U2 - 10.1016/j.healthpo1.2012.06.006

DO - 10.1016/j.healthpo1.2012.06.006

M3 - Review article

VL - 107

SP - 108

EP - 145

JO - Health Policy

JF - Health Policy

SN - 0168-8510

IS - 2-3

ER -

de Bruin SR, Versnel N, Lemmens LC, Molema CCM, Schellevis FG, Nijpels G et al. Comprehensive care programs for patients with multiple chronic conditions: A systematic literature review. Health Policy. 2012 Oct;107(2-3):108-145. https://doi.org/10.1016/j.healthpo1.2012.06.006