Abstract

BackgroundThe burden of chronic disease on patients and the health service is growing. Current health policy emphasises the need for services which provide integrated and co-ordinated care for patients with chronic diseases, but there is uncertainty about which integrated care interventions and service models may be most effective. This review of reviews aims to synthesise the available evidence about the effectiveness of such interventions and service models in terms of patient experience of health and social care, the use of hospital and other health resources, and the associated costs.Methods/DesignWe will search MEDLINE, Embase, ASSIA, PsycINFO, HMIC, CINAHL, Cochrane Library (including HTA Database, DARE and Cochrane Database of Systematic Reviews), EPPI-Centre, TRIP, and Health Economic Evaluations databases for English language systematic reviews and meta-analyses published since 2000 that have evaluated the effectiveness of integrated care interventions for patients with chronic diseases. Interventions must deliver care that crosses the boundary between at least two health and/or social care settings. Outcomes of interest are healthcare resource use, patient quality of life/satisfaction, costs, and care co-ordination. Data from eligible reviews will be extracted by two independent reviewers and will include study details, the design, delivery and co-ordination of interventions, and methodological quality. Evidence synthesis will focus on a narrative overview of interventions and their effectiveness.DiscussionThe review aims to summarise the evidence base about the effectiveness of integrated care interventions and service models and describe how interventions have been organised, co-ordinated, and delivered. The findings have the potential to impact on the commissioning of health and social care services in the UK which aim to provide integrated and co-ordinated care for patients with chronic disease and multimorbidity.Systematic review registrationPROSPERO CRD42015016458.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0055-x) contains supplementary material, which is available to authorized users.

Highlights

  • The burden of chronic disease on patients and the health service is growing

  • The findings have the potential to impact on the commissioning of health and social care services in the United Kingdom (UK) which aim to provide integrated and co-ordinated care for patients with chronic disease and multimorbidity

  • The UK government has announced a series of ‘integrated care pioneers’ to fast-track attempts to facilitate co-ordinated care alongside the introduction of the Better Care Fund to promote joint working between National Health Service (NHS) and social care organisations at a strategic level [6,7]

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Summary

Introduction

The burden of chronic disease on patients and the health service is growing. Current health policy emphasises the need for services which provide integrated and co-ordinated care for patients with chronic diseases, but there is uncertainty about which integrated care interventions and service models may be most effective. In general terms, integrated care is an organising principle for healthcare delivery which aims to provide co-ordinated and patientcentred care [2] This is pertinent for people with chronic conditions, who often require long-term care that crosses conventional care service boundaries but who typically experience fragmented and poorly co-ordinated management [3,4]. The pressure to integrate services is largely being driven by the predicted significant increase in the number of patients with chronic diseases and multimorbidity in the coming years—the number of people with three or more chronic conditions is expected to rise from 1.9 million in 2008 to 2.9 million by 2018 [5] This will inevitably be accompanied by a sharp increase in the Damery et al Systematic Reviews (2015) 4:64 costs associated with the management of patients with complex health and social care needs.

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