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Aspects of Multicom...
Aspects of Multicomponent Integrated Care Promote Sustained Improvement in Surrogate Clinical Outcomes: A Systematic Review and Meta-analysis.
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Lim, Lee Ling (author)
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Lau, Eric S H (author)
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Kong, Alice P S (author)
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Davies, Melanie J (author)
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Levitt, Naomi S (author)
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- Eliasson, Björn, 1959 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
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Aguilar-Salinas, Carlos A (author)
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Ning, Guang (author)
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Seino, Yutaka (author)
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So, Wing Yee (author)
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McGill, Margaret (author)
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Ogle, Graham D (author)
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Orchard, Trevor J (author)
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Clarke, Philip (author)
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Holman, Rury R (author)
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Gregg, Edward W (author)
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Gagliardino, Juan José (author)
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Chan, Juliana C N (author)
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(creator_code:org_t)
- 2018-05-11
- 2018
- English.
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In: Diabetes care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 41:6, s. 1312-1320
- Related links:
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https://care.diabete...
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https://gup.ub.gu.se...
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https://doi.org/10.2...
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Abstract
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- The implementation of the Chronic Care Model (CCM) improves health care quality. We examined the sustained effectiveness of multicomponent integrated care in type 2 diabetes.We searched PubMed and Ovid MEDLINE (January 2000-August 2016) and identified randomized controlled trials comprising two or more quality improvement strategies from two or more domains (health system, health care providers, or patients) lasting ≥12 months with one or more clinical outcomes. Two reviewers extracted data and appraised the reporting quality.In a meta-analysis of 181 trials (N = 135,112), random-effects modeling revealed pooled mean differences in HbA1c of -0.28% (95% CI -0.35 to -0.21) (-3.1 mmol/mol [-3.9 to -2.3]), in systolic blood pressure (SBP) of -2.3 mmHg (-3.1 to -1.4), in diastolic blood pressure (DBP) of -1.1 mmHg (-1.5 to -0.6), and in LDL cholesterol (LDL-C) of -0.14 mmol/L (-0.21 to -0.07), with greater effects in patients with LDL-C ≥3.4 mmol/L (-0.31 vs. -0.10 mmol/L for <3.4 mmol/L; Pdifference = 0.013), studies from Asia (HbA1c -0.51% vs. -0.23% for North America [-5.5 vs. -2.5 mmol/mol]; Pdifference = 0.046), and studies lasting >12 months (SBP -3.4 vs. -1.4 mmHg, Pdifference = 0.034; DBP -1.7 vs. -0.7 mmHg, Pdifference = 0.047; LDL-C -0.21 vs. -0.07 mmol/L for 12-month studies, Pdifference = 0.049). Patients with median age <60 years had greater HbA1c reduction (-0.35% vs. -0.18% for ≥60 years [-3.8 vs. -2.0 mmol/mol]; Pdifference = 0.029). Team change, patient education/self-management, and improved patient-provider communication had the largest effect sizes (0.28-0.36% [3.0-3.9 mmol/mol]).Despite the small effect size of multicomponent integrated care (in part attenuated by good background care), team-based care with better information flow may improve patient-provider communication and self-management in patients who are young, with suboptimal control, and in low-resource settings.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
Keyword
- Adult
- Chronic Disease
- therapy
- Delivery of Health Care
- Integrated
- standards
- Diabetes Mellitus
- Type 2
- therapy
- Female
- Humans
- Middle Aged
- Physician-Patient Relations
- Quality of Health Care
- standards
- Randomized Controlled Trials as Topic
- Self-Management
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Lim, Lee Ling
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Lau, Eric S H
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Kong, Alice P S
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Davies, Melanie ...
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Levitt, Naomi S
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Eliasson, Björn, ...
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show more...
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Aguilar-Salinas, ...
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Ning, Guang
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Seino, Yutaka
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So, Wing Yee
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McGill, Margaret
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Ogle, Graham D
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Orchard, Trevor ...
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Clarke, Philip
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Holman, Rury R
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Gregg, Edward W
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Gagliardino, Jua ...
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Chan, Juliana C ...
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Endocrinology an ...
- Articles in the publication
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Diabetes care
- By the university
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University of Gothenburg