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The Effectiveness of Patient-Centred Medical Home-Based Models of Care versus Standard Primary Care in Chronic Disease Management: A Systematic Review and Meta-Analysis of Randomised and Non-Randomised Controlled Trials

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  • James Rufus John

    (Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia
    Rozetta Institute, Level 4, 55 Harrington Street, Sydney, NSW 2000, Australia)

  • Hir Jani

    (Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia)

  • Kath Peters

    (School of Nursing and Midwifery, Western Sydney University, Sydney, NSW 2560, Australia)

  • Kingsley Agho

    (Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia
    School of Science and Health, Western Sydney University, Sydney, NSW 2560, Australia)

  • W. Kathy Tannous

    (Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia
    School of Business, Western Sydney University, Sydney, NSW 2150, Australia)

Abstract

Patient-centred care by a coordinated primary care team may be more effective than standard care in chronic disease management. We synthesised evidence to determine whether patient-centred medical home (PCMH)-based care models are more effective than standard general practitioner (GP) care in improving biomedical, hospital, and economic outcomes. MEDLINE, CINAHL, Embase, Cochrane Library, and Scopus were searched to identify randomised (RCTs) and non-randomised controlled trials that evaluated two or more principles of PCMH among primary care patients with chronic diseases. Study selection, data extraction, quality assessment using Joanna Briggs Institute (JBI) appraisal tools, and grading of evidence using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach were conducted independently. A quantitative synthesis, where possible, was pooled using random effects models and the effect size estimates of standardised mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals were reported. Of the 13,820 citations, we identified 78 eligible RCTs and 7 quasi trials which included 60,617 patients. The findings suggested that PCMH-based care was associated with significant improvements in depression episodes (SMD −0.24; 95% CI −0.35, −0.14; I 2 = 76%) and increased odds of remission (OR 1.79; 95% CI 1.46, 2.21; I 2 = 0%). There were significant improvements in the health-related quality of life (SMD 0.10; 95% CI 0.04, 0.15; I 2 = 51%), self-management outcomes (SMD 0.24; 95% CI 0.03, 0.44; I 2 = 83%), and hospital admissions (OR 0.83; 95% CI 0.70, 0.98; I 2 = 0%). In terms of biomedical outcomes, with exception to total cholesterol, PCMH-based care led to significant improvements in blood pressure, glycated haemoglobin, and low-density lipoprotein cholesterol outcomes. The incremental cost of PCMH care was identified to be small and significantly higher than standard care (SMD 0.17; 95% CI 0.08, 0.26; I 2 = 82%). The quality of individual studies ranged from “fair” to “good” by meeting at least 60% of items on the quality appraisal checklist. Additionally, moderate to high heterogeneity across studies in outcomes resulted in downgrading the included studies as moderate or low grade of evidence. PCMH-based care has been found to be superior to standard GP care in chronic disease management. Results of the review have important implications that may inform patient, practice, and policy-level changes.

Suggested Citation

  • James Rufus John & Hir Jani & Kath Peters & Kingsley Agho & W. Kathy Tannous, 2020. "The Effectiveness of Patient-Centred Medical Home-Based Models of Care versus Standard Primary Care in Chronic Disease Management: A Systematic Review and Meta-Analysis of Randomised and Non-Randomise," IJERPH, MDPI, vol. 17(18), pages 1-42, September.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:18:p:6886-:d:416624
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    1. repec:mpr:mprres:7381 is not listed on IDEAS
    2. Jonathan Stokes & Maria Panagioti & Rahul Alam & Kath Checkland & Sudeh Cheraghi-Sohi & Peter Bower, 2015. "Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-42, July.
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    Cited by:

    1. Zoe Zon Be Lim & Mumtaz Mohamed Kadir & Mimaika Luluina Ginting & Hubertus Johannes Maria Vrijhoef & Joanne Yoong & Chek Hooi Wong, 2021. "Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations," IJERPH, MDPI, vol. 18(21), pages 1-20, October.
    2. Shilpa Surendran & Chuan De Foo & Chen Hee Tam & Elaine Qiao Ying Ho & David Bruce Matchar & Josip Car & Gerald Choon Huat Koh, 2021. "The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context," IJERPH, MDPI, vol. 18(4), pages 1-11, February.
    3. Gloria Reig-Garcia & Rosa Suñer-Soler & Susana Mantas-Jiménez & Anna Bonmatí-Tomas & Maria Carmen Malagón-Aguilera & Cristina Bosch-Farré & Sandra Gelabert-Viella & Dolors Juvinyà-Canal, 2021. "Assessing Nurses’ Satisfaction with Continuity of Care and the Case Management Model as an Indicator of Quality of Care in Spain," IJERPH, MDPI, vol. 18(12), pages 1-12, June.
    4. Mimaika Luluina Ginting & Chek Hooi Wong & Zoe Zon Be Lim & Robin Wai Munn Choo & Sheena Camilla Hirose Carlsen & Grace Sum & Hubertus Johannes Maria Vrijhoef, 2022. "A Patient-Centred Medical Home Care Model for Community-Dwelling Older Adults in Singapore: A Mixed-Method Study on Patient’s Care Experience," IJERPH, MDPI, vol. 19(8), pages 1-24, April.
    5. Sharon Ngoh & Wern Ee Tang & Edwin Chng & Phui-Nah Chong, 2022. "Comment on Surendran et al. The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context. Int. J. Environ. Res. Public Health 2021, 18 , 1817," IJERPH, MDPI, vol. 19(8), pages 1-4, April.
    6. Angélique Herrler & Helena Kukla & Vera Vennedey & Stephanie Stock, 2022. "What matters to people aged 80 and over regarding ambulatory care? A systematic review and meta-synthesis of qualitative studies," European Journal of Ageing, Springer, vol. 19(3), pages 325-339, September.
    7. Ryuichi Ohta & Yoshinori Ryu & Takuji Katsube & Chiaki Sano, 2020. "Rural Homecare Nurses’ Challenges in Providing Seamless Patient Care in Rural Japan," IJERPH, MDPI, vol. 17(24), pages 1-11, December.

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