title: Specialized community-based care: an evidence-based analysis.
abstract: BACKGROUND
  Specialized community-based care (SCBC) refers to services that manage chronic illness through formalized links between primary and specialized care.
  
  
  OBJECTIVE
  The objectives of this evidence-based analysis (EBA) were as follows: to summarize the literature on SCBC, also known as intermediate care to synthesize the evidence from previous Medical Advisory Secretariat (now Health Quality Ontario) EBAs on SCBC for heart failure, diabetes, chronic obstructive pulmonary disease (COPD), and chronic wounds to examine the role of SCBC in family practice
  
  
  RESULTS
  PART 1: SYSTEMATIC REVIEW OF INTERMEDIATE CARE: Seven systematic reviews on intermediate care since 2008 were identified. The literature base is complex and difficult to define. There is evidence to suggest that intermediate care is effective in improving outcomes; however, the effective interventions are still uncertain. PART 2: SYNTHESIS OF EVIDENCE IN INTERMEDIATE CARE MORTALITY: Heart failure Significant reduction in patients receiving SCBC COPD Nonsignificant reduction in patients receiving SCBC HOSPITALIZATION: Heart failure Nonsignificant reduction in patients receiving SCBC COPD Significant reduction in patients receiving SCBC EMERGENCY DEPARTMENT VISITS: Heart failure Nonsignificant reduction in patients receiving SCBC COPD Significant reduction in patients receiving SCBC DISEASE-SPECIFIC PATIENT OUTCOMES: COPD Nonsignificant improvement in lung function in patients receiving SCBC Diabetes Significant reduction in hemoglobin A1c (HbA1c) and systolic blood pressure in patients receiving SCBC Chronic wounds Significant increase in the proportion of healed wounds in patients receiving SCBC QUALITY OF LIFE: Heart failure Trend toward improvement in patients receiving SCBC COPD Significant improvement in patients receiving SCBC PART 3: INTERMEDIATE CARE IN FAMILY PRACTICE--EVIDENCE-BASED ANALYSIS: Five randomized controlled trials were identified comparing SCBC to usual care in family practice. Inclusion criteria were 1) the presence of multiple chronic conditions, and 2) interventions that included 2 or more health care professions. The GRADE quality of the evidence was assessed as low for all outcomes due to the inconsistency and indirectness of the results.
  
  
  CONCLUSIONS
  This review did not look at disease-specific studies on intermediate care in family practice.
  
  
  CONCLUSIONS
  Specialized community-based care effectively improves outcomes in patients with heart failure, COPD, and diabetes. The effectiveness of SCBC in family practice is unclear.
authors.affiliation: Health Quality Ontario, 130 Bloor Street West, 10th Floor, Toronto, Ontario, M5S 1N5, Canada. EvidenceInfo@hqontario.ca
mesh_terms: D002908:Chronic Disease; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000191:economics / Q000401:mortality / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D055317:Evidence-Based Practice; D005194:Family Practice; D006302:Health Services Research; D006333:Heart Failure / Q000191:economics / Q000401:mortality / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D009864:Ontario; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D062072:Patient Acuity; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000401:mortality / Q000628:therapy; D011787:Quality of Health Care; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D014947:Wounds and Injuries / Q000191:economics / Q000628:therapy