title: Integrated care programmes for chronically ill patients: a review of systematic reviews.
abstract: OBJECTIVE
  To investigate effectiveness, definitions, and components of integrated care programmes for chronically ill patients on the basis of systematic reviews.
  
  
  METHODS
  Literature review from January 1996 to May 2004.
  
  
  METHODS
  Definitions and components of integrated care programmes and all effects reported on the quality of care.
  
  
  RESULTS
  Searches in the Medline and Cochrane databases identified 13 systematic reviews of integrated care programmes for chronically ill patients. Despite considerable heterogeneity in interventions, patient populations, and processes and outcomes of care, integrated care programmes seemed to have positive effects on the quality of patient care. No consistent definitions were present for the management of patients with chronic illnesses. In all the reviews the aims of integrated care programmes were very similar, namely reducing fragmentation and improving continuity and coordination of care, but the focus and content of the programmes differed widely. The most common components of integrated care programmes were self-management support and patient education, often combined with structured clinical follow-up and case management; a multidisciplinary patient care team; multidisciplinary clinical pathways and feedback, reminders, and education for professionals.
  
  
  CONCLUSIONS
  Integrated care programmes seemed to have positive effects on the quality of care. However, integrated care programmes have widely varying definitions and components and failure to recognize these variations leads to inappropriate conclusions about the effectiveness of these programmes and to inappropriate application of research results. To compare programmes and better understand the (cost) effectiveness of the programmes, consistent definitions must be used and component interventions must be well described.
authors.affiliation: Centre for Quality of Care Research (WOK), Radbound University Nijmegen Medical Centre, Nijmegen, The Netherlands. M.Ouwens@wok.umcn.nl
authors.forename: Marielle
authors.initials: M
authors.lastname: Ouwens
authors.forename: Hub
authors.initials: H
authors.lastname: Wollersheim
authors.forename: Rosella
authors.initials: R
authors.lastname: Hermens
authors.forename: Marlies
authors.initials: M
authors.lastname: Hulscher
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D016206:Databases, Bibliographic; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D019468:Disease Management; D006302:Health Services Research; D006801:Humans; D011785:Quality Assurance, Health Care; D000078202:Systematic Reviews as Topic