Individualized plans of care to improve outcomes among children and adults with chronic illness: a systematic review.
BACKGROUND
Adults and children with chronic illness often require services from multiple providers. Individualized plans of care (IPCs) are sometimes developed to improve care coordination. However, their association with improved outcomes is unknown.


METHODS
We searched literature published between January 2001 and October 2011, using Medline, CINAHL, EMBASE, PsychINFO, and bibliographic review. Eligible studies involved an IPC with input from the patient and/or family of individuals with chronic illness, evaluated outcomes, and were conducted in the United States. We assessed evidence quality using Oxford Centre for Evidence-Based Medicine criteria.


RESULTS
15 studies met inclusion criteria. Studies were heterogeneous regarding populations and outcomes examined and were generally low quality. Most described IPC use within a multifaceted care coordination intervention. The strongest evidence links IPC use and symptom improvement in depressed adults; the weakest evidence exists for outcomes in children. Vague descriptions of the IPCs' limited analysis.


CONCLUSIONS
Current evidence supporting an association between IPC use and improved outcomes, particularly among children, is sparse. Well-designed evaluations of clearly described IPCs are needed to examine who should be involved in their development, what they should include, and how often they should be updated to improve outcomes of care for this vulnerable population.
K Casey
KC
Lion
Rita
R
Mangione-Smith
Maria T
MT
Britto
D000328:Adult; D019090:Case Management / Q000458:organization & administration / Q000592:standards* / Q000639:trends; D002648:Child; D002908:Chronic Disease / Q000628:therapy*; D016206:Databases, Bibliographic; D019468:Disease Management; D006801:Humans; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care / Q000458:organization & administration / Q000592:standards* / Q000639:trends; D011785:Quality Assurance, Health Care; D016896:Treatment Outcome