title: Comprehensive care programs for patients with multiple chronic conditions: a systematic literature review.
abstract: OBJECTIVE
  To provide insight into the characteristics of comprehensive care programs for patients with multiple chronic conditions and their impact on patients, informal caregivers, and professional caregivers.
  
  
  METHODS
  Systematic literature search in multiple electronic databases for English language papers published between January 1995 and January 2011, supplemented by reference tracking and a manual search on the internet. Wagner's chronic care model (CCM) was used to define comprehensive care. After inclusion, the methodological quality of each study was assessed. A best-evidence synthesis was applied to draw conclusions.
  
  
  RESULTS
  Forty-two publications were selected describing thirty-three studies evaluating twenty-eight comprehensive care programs for multimorbid patients. Programs varied in the target patient groups, implementation settings, number of included interventions, and number of CCM components to which these interventions related. Moderate evidence was found for a beneficial effect of comprehensive care on inpatient healthcare utilization and healthcare costs, health behavior of patients, perceived quality of care, and satisfaction of patients and caregivers. Insufficient evidence was found for a beneficial effect of comprehensive care on health-related quality of life in terms of mental functioning, medication use, and outpatient healthcare utilization and healthcare costs. No evidence was found for a beneficial effect of comprehensive care on cognitive functioning, depressive symptoms, functional status, mortality, quality of life in terms of physical functioning, and caregiver burden.
  
  
  CONCLUSIONS
  Because of the heterogeneity of comprehensive care programs, it is as yet too early to draw firm conclusions regarding their effectiveness. More rigorous evaluation studies are necessary to determine what constitutes best care for the increasing number of people with multiple chronic conditions.
authors.affiliation: National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, P.O. Box 1, 3720 BA Bilthoven, The Netherlands. simone.de.bruin@rivm.nl
authors.forename: Simone R
authors.initials: SR
authors.lastname: de Bruin
authors.forename: Nathalie
authors.initials: N
authors.lastname: Versnel
authors.forename: Lidwien C
authors.initials: LC
authors.lastname: Lemmens
authors.forename: Claudia C M
authors.initials: CC
authors.lastname: Molema
authors.forename: François G
authors.initials: FG
authors.lastname: Schellevis
authors.forename: Giel
authors.initials: G
authors.lastname: Nijpels
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Baan
mesh_terms: D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D003191:Comprehensive Health Care / Q000458:organization & administration*; D006801:Humans