Abstract
BackgroundThe increasing prevalence of chronic disease and even multiple chronic diseases faced by both developed and developing countries is of considerable concern. Many of the interventions to address this within primary healthcare settings are based on a chronic care model first developed by MacColl Institute for Healthcare Innovation at Group Health Cooperative.MethodsThis systematic literature review aimed to identify and synthesise international evidence on the effectiveness of elements that have been included in a chronic care model for improving healthcare practices and health outcomes within primary healthcare settings. The review broadens the work of other similar reviews by focusing on effectiveness of healthcare practice as well as health outcomes associated with implementing a chronic care model. In addition, relevant case series and case studies were also included.ResultsOf the 77 papers which met the inclusion criteria, all but two reported improvements to healthcare practice or health outcomes for people living with chronic disease. While the most commonly used elements of a chronic care model were self-management support and delivery system design, there were considerable variations between studies regarding what combination of elements were included as well as the way in which chronic care model elements were implemented. This meant that it was impossible to clearly identify any optimal combination of chronic care model elements that led to the reported improvements.ConclusionsWhile the main argument for excluding papers reporting case studies and case series in systematic literature reviews is that they are not of sufficient quality or generalizability, we found that they provided a more detailed account of how various chronic care models were developed and implemented. In particular, these papers suggested that several factors including supporting reflective healthcare practice, sending clear messages about the importance of chronic disease care and ensuring that leaders support the implementation and sustainability of interventions may have been just as important as a chronic care model’s elements in contributing to the improvements in healthcare practice or health outcomes for people living with chronic disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0854-8) contains supplementary material, which is available to authorized users.
Highlights
The increasing prevalence of chronic disease and even multiple chronic diseases faced by both developed and developing countries is of considerable concern
A further six studies were conducted in Australia and New Zealand [21,89,90,91,92,93], one study was conducted in Taiwan [94], one in the United Arab Emirates [95] and one in South Africa [96] [see Additional file 1: Table S6]
Contextual relevance is especially important given that the burden of chronic disease is highest within disadvantaged populations, the majority of studies which have implemented the eight Chronic care model (CCM) elements included in this review have focused on interventions within advantaged populations living in developed countries [see Additional file 1: Table S6]
Summary
The increasing prevalence of chronic disease and even multiple chronic diseases faced by both developed and developing countries is of considerable concern. Many of the current chronic disease management strategies were first identified by MacColl Institute for Healthcare Innovation at Group Health Cooperative, commonly referred to as the Wagner chronic care model (Wagner CCM), which was based on six key elements [5,6,7]. These elements focus on mobilising community resources, promoting high quality care, enabling patient self-management, implementing care consistent with evidence and patient preferences, effectively using patient/ population data, cultural competence, care coordination, and health promotion [8].
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