Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes: a systematic review

Authors: Carol Davy, Jonathan Bleasel, Hueiming Liu, Maria Tchan, Sharon Ponniah and Alex Brown

Abstract

Background

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 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.

Methods

This 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 broadensthe 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.

Results

Of 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.

Conclusions

While 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.

Citation: Carol Davy, Jonathan Bleasel, Hueiming Liu, Maria Tchan, Sharon Ponniah and Alex Brown Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes: a systematic review BMC Health Services Research 2015, 15:194  doi:10.1186/s12913-015-0854-8

Received: 24 December 2014 Accepted: 27 April 2015 Published: 10 May 2015

Copyright: © 2015 Davyetal.;licensee BioMed Central This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricteduse, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waive (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
 
Abbreviations

ACIC, Assessment of chronic illness care; CM, Case management; CCM, Chronic care model; COPD, Chronic obstructive pulmonary disease; CIS, Clinic information system; CS, Community support; DS, Decision support; DSD, Delivery system design; S, Family support; HS, Health system; RCTs, Randomised control trials; SMS, Self-management support

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

CD participated in the design of the study, the literature search, assessment of quality and bias, extraction of findings and drafting the manuscript. JB participated in the extraction of findings and drafting the manuscript. HL and MT participated in the literature search, assessment of quality and bias and extraction of findings. SP participated in the design of the study, the literature search, assessment of quality and bias, and extraction of findings. AB participated in the design of the study. All authors read and approved the final manuscript.

Acknowledgements

This research and the researchers working on this study were supported by a Centre for Research Excellence Grant from the Australian Primary Health Care Research Institute. AB  is supported by a post-doctoral fellowship from the National Heart Foundation (#PR 08 M 4207) and a senior medical research fellowship from the Viertel Charitable Foundation.

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