Abstract
BackgroundStudies suggest that the Patient-Centred Medical Home (PCMH) model of primary care is more effective than standard care for improving clinical outcomes in patients with chronic diseases (non-communicable diseases), but the strength of the evidence base is unclear. The aim of the proposed systematic review is to generate a current synthesis of relevant studies on the effectiveness of PCMH model of primary care versus standard care in chronic disease management.MethodsElectronic databases such as MEDLINE, CINAHL, Embase, Cochrane Library, and Scopus will be searched using predefined search terms for PCMH, primary care, and chronic diseases for articles published up to November 2018. Reference lists of included articles and relevant reviews will also be hand searched. This review will consider eligible randomised controlled trials and controlled trials against predetermined criteria including two or more principles of PCMH model endorsed by Australian Medical Association. Data extraction will be performed independently by two reviewers, and retrieved papers will be assessed for quality using JBI Critical Appraisal Tools. Where possible, quantitative data will be pooled in statistical meta-analysis using the R packages ‘Meta’ and ‘metafor’. Effect sizes will be expressed as odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for meta-analysis; robustness will be explored using sensitivity analysis. Heterogeneity will be assessed narratively and statistically using the Q statistics and visualised using Baujat plots including subgroup or sensitivity analyses techniques where possible. Where statistical pooling is not possible, the findings will be presented narratively.DiscussionThe findings of the proposed systematic review will provide the highest level of evidence to date on the effectiveness of the PCMH model versus standard primary care in chronic disease management. We believe that our findings will inform patients, primary care providers, and public health administrators and policy-makers on the benefits and risks of PCMH model of care.Systematic review registrationPROSPERO CRD42018085378
Highlights
Studies suggest that the Patient-Centred Medical Home (PCMH) model of primary care is more effective than standard care for improving clinical outcomes in patients with chronic diseases, but the strength of the evidence base is unclear
The findings of the proposed systematic review will provide the highest level of evidence to date on the effectiveness of the PCMH model versus standard primary care in chronic disease management
We believe that our findings will inform patients, primary care providers, and public health administrators and policy-makers on the benefits and risks of PCMH model of care
Summary
Research design and methodology This protocol was developed with guidance from the Centre for Reviews and Dissemination’s (CRD) Guidance for undertaking reviews in health care and Preferred. Types of participants This review will consider adult populations (over 18 years of age) treated for one or more chronic disease in a primary care setting. Types of interventions This review will include studies which satisfy the following criteria based on the principles of PCMH recommended by the AMA [15, 33]: 1) Integrated primary health care or MDT approaches. Types of outcomes This review will consider studies that report clinically relevant outcomes which include, but are not limited to hospital outcomes (e.g. service use, admissions, and emergency department visits), patient clinical outcomes (e.g. medical, psychological, and physical/functional), and economic outcomes (e.g. health care costs, cost-effectiveness, and cost-benefit analyses). Discrepancies or disagreements at any stage (i.e. search strategy, data extraction, and quality assessment) will be resolved through discussion with a third author to achieve consensus. We will grade the body of evidence for recommendations following the approach proposed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group [36]
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