title: Integrated care programmes for adults with chronic conditions: a meta-review.
abstract: OBJECTIVE
  To review systematic reviews and meta-analyses of integrated care programmes in chronically ill patients, with a focus on methodological quality, elements of integration assessed and effects reported.
  
  
  METHODS
  Meta-review of systematic reviews and meta-analyses identified in Medline (1946-March 2012), Embase (1980-March 2012), CINHAL (1981-March 2012) and the Cochrane Library of Systematic Reviews (issue 1, 2012).
  
  
  METHODS
  Methodological quality assessed by the 11-item Assessment of Multiple Systematic Reviews (AMSTAR) checklist; elements of integration assessed using a published list of 10 key principles of integration; effects on patient-centred outcomes, process quality, use of healthcare and costs.
  
  
  RESULTS
  Twenty-seven systematic reviews were identified; conditions included chronic heart failure (CHF; 12 reviews), diabetes mellitus (DM; seven reviews), chronic obstructive pulmonary disease (COPD; seven reviews) and asthma (five reviews). The median number of AMSTAR checklist items met was five: few reviewers searched for unpublished literature or described the primary studies and interventions in detail. Most reviews covered comprehensive services across the care continuum or standardization of care through inter-professional teams, but organizational culture, governance structure or financial management were rarely assessed. A majority of reviews found beneficial effects of integration, including reduced hospital admissions and re-admissions (in CHF and DM), improved adherence to treatment guidelines (DM, COPD and asthma) or quality of life (DM). Few reviews showed reductions in costs.
  
  
  CONCLUSIONS
  Systematic reviews of integrated care programmes were of mixed quality, assessed only some components of integration of care, and showed consistent benefits for some outcomes but not others.
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, CH-3012 Bern, Switzerland Institute of General Practice and Health Services Research, University of Zurich, CH-8091 Zurich, Switzerland.
authors.forename: Nahara Anani
authors.initials: NA
authors.lastname: Martínez-González
authors.affiliation: College M, College for Management in Health Care, CH-3010 Bern, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Berchtold
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, CH-3012 Bern, Switzerland.
authors.forename: Klara
authors.initials: K
authors.lastname: Ullman
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, CH-3012 Bern, Switzerland.
authors.forename: André
authors.initials: A
authors.lastname: Busato
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, CH-3012 Bern, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D003191:Comprehensive Health Care / Q000458:organization & administration*; D003266:Continuity of Patient Care; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D015279:Organizational Culture; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D011788:Quality of Life; D018511:Systems Integration
keywords: chronic conditions; health services research; integrated healthcare; quality improvement; systematic review
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