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BMC Health Services Research

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Open Access 01-12-2015 | Research article

Context, mechanisms and outcomes of integrated care for diabetes mellitus type 2: a systematic review

Authors: Loraine Busetto, Katrien Ger Luijkx, Arianne Mathilda Josephus Elissen, Hubertus Johannes Maria Vrijhoef

Published in: BMC Health Services Research | Issue 1/2016

Abstract

Background

Integrated care interventions for chronic conditions can lead to improved outcomes, but it is not clear when and why this is the case. This study aims to answer the following two research questions: First, what are the context, mechanisms and outcomes of integrated care for people with type 2 diabetes? Second, what are the relationships between context, mechanisms and outcomes of integrated care for people with type 2 diabetes?

Methods

A systematic literature search was conducted for the period 2003–2013 in Cochrane and PubMed. Articles were included when they focussed on integrated care and type 2 diabetes, and concerned empirical research analysing the implementation of an intervention. Data extraction was performed using a common data extraction table. The quality of the studies was assessed with the Mixed Methods Appraisal Tool. The CMO model (context + mechanism = outcome) was used to study the relationship between context factors (described by the barriers and facilitators encountered in the implementation process and categorised at the six levels of the Implementation Model), mechanisms (defined as intervention types and described by their number of Chronic Care Model (sub-)components) and outcomes (the intentional and unintentional effects triggered by mechanism and context).

Results

Thirty-two studies met the inclusion criteria. Most reported barriers to the implementation process were found at the organisational context level and most facilitators at the social context level. Due to the low number of articles reporting comparable quantitative outcome measures or in-depth qualitative information, it was not possible to make statements about the relationship between context, mechanisms and outcomes.

Conclusions

Efficient resource allocation should entail increased investments at the organisational context level where most barriers are expected to occur. It is likely that investments at the social context level will also help to decrease the development of barriers at the organisational context level, especially by increasing staff involvement and satisfaction. If future research is to adequately inform practice and policy regarding the impact of these efforts on health outcomes, focus on the actual relationships between context, mechanisms and outcomes should be actively incorporated into study designs.

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Title: Context, mechanisms and outcomes of integrated care for diabetes mellitus type 2: a systematic review
Authors: Loraine Busetto
Katrien Ger Luijkx
Arianne Mathilda Josephus Elissen
Hubertus Johannes Maria Vrijhoef
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-015-1231-3

At a glance: The STEP trials

Springer Medicine

Context, mechanisms and outcomes of integrated care for diabetes mellitus type 2: a systematic review

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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