title: The Evidence-base for Using Ontologies and Semantic Integration Methodologies to Support Integrated Chronic Disease Management in Primary and Ambulatory Care: Realist Review. Contribution of the IMIA Primary Health Care Informatics WG.
abstract: BACKGROUND
  Most chronic diseases are managed in primary and ambulatory care. The chronic care model (CCM) suggests a wide range of community, technological, team and patient factors contribute to effective chronic disease management. Ontologies have the capability to enable formalised linkage of heterogeneous data sources as might be found across the elements of the CCM.
  
  
  OBJECTIVE
  To describe the evidence base for using ontologies and other semantic integration methods to support chronic disease management.
  
  
  METHODS
  We reviewed the evidence-base for the use of ontologies and other semantic integration methods within and across the elements of the CCM. We report them using a realist review describing the context in which the mechanism was applied, and any outcome measures.
  
  
  RESULTS
  Most evidence was descriptive with an almost complete absence of empirical research and important gaps in the evidence-base. We found some use of ontologies and semantic integration methods for community support of the medical home and for care in the community. Ubiquitous information technology (IT) and other IT tools were deployed to support self-management support, use of shared registries, health behavioural models and knowledge discovery tools to improve delivery system design. Data quality issues restricted the use of clinical data; however there was an increased use of interoperable data and health system integration.
  
  
  CONCLUSIONS
  Ontologies and semantic integration methods are emergent with limited evidence-base for their implementation. However, they have the potential to integrate the disparate community wide data sources to provide the information necessary for effective chronic disease management.
authors: University of Surrey, Clinical Informatics & Health Outcomes research group, Department of Health Care Policy and Management, GUILDFORD, Surrey GU2 7XH, United Kingdom. E-mail: s.lusignan@surrey.ac.uk.
authors: H
authors: H
authors: Liyanage
authors: S-T
authors: ST
authors: Liaw
authors: C
authors: C
authors: Kuziemsky
authors: A L
authors: AL
authors: Terry
authors: S
authors: S
authors: Jones
authors: J K
authors: JK
authors: Soler
authors: S
authors: S
authors: de Lusignan
mesh_terms: D000553:Ambulatory Care; D002908:Chronic Disease; D003695:Delivery of Health Care; D019468:Disease Management; D006801:Humans; D008490:Medical Informatics; D011320:Primary Health Care; D012660:Semantics