Journal article
Core components and impact of nurse-led integrated care models for home-dwelling older people: A systematic review and meta-analysis.
- Deschodt M Department Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Herestraat 49 ON1 box 707, 3000 Leuven, Belgium. Electronic address: mieke.deschodt@kuleuven.be.
- Laurent G Department Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
- Cornelissen L Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Herestraat 49 ON1 box 707, 3000 Leuven, Belgium.
- Yip O Department Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland. Electronic address: olivia.yip@unibas.ch.
- Zúñiga F Department Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland. Electronic address: Franziska.zuniga@unibas.ch.
- Denhaerynck K Department Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland. Electronic address: kris.denhaerynck@unibas.ch.
- Briel M Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada; Department Clinical Research, University of Basel, University Hospital Basel, Schanzenstrasse 55, 4031 Basel, Switzerland. Electronic address: Matthias.Briel@usb.ch.
- Karabegovic A Spitex Zürich Limmat AG Fachentwicklung Chronic Care Kompetenz-Zentrum Spitex Zürich, Rotbuchstrasse 46, 8037 Zürich, Switzerland. Electronic address: Azra.Karabegovic@spitex-zuerich.ch.
- De Geest S Department Public Health, Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d - box 7001, 3000 Leuven, Belgium. Electronic address: sabina.degeest@unibas.ch.
- 2020-03-23
Published in:
- International journal of nursing studies. - 2020
Activities of daily living
Community health nursing
Delivery of health care, integrated
Frail elderly
Health services for the aged
Meta-analysis
Patient-centred care
Quality of life
English
BACKGROUND
Integrated care models are highly recommended to overcome care fragmentation in the multimorbid older population. Nurses are potentially ideally situated to fulfil the role as care coordinator to guide integrated care. No systematic review has been conducted specifically focusing on the impact of nurse-led integrated care models for older people in community settings.
OBJECTIVES
To identify core components of nurse-led integrated care models for the home-dwelling older population; to describe patient, service and process outcomes; and to evaluate the impact of these care models on quality of life, activities of daily living, hospitalisation, emergency department visits, nursing home admissions and mortality.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
English, Dutch, French, German and Spanish articles selected from PubMed and CINAHL, hand-search of reference lists of the included articles and grey literature.
REVIEW METHODS
A systematic search was conducted to identify prospective experimental or quasi-experimental studies detailing nurse-led integrated care models in the older home-dwelling population. Study characteristics and reported outcomes were tabulated. The core components of the models were mapped using the Sustainable intEgrated chronic care modeLs for multi-morbidity: delivery, FInancing, and performancE (SELFIE) framework. A random effects meta-analysis was conducted to study the overall effectiveness of the included care models on health-related quality of life, activities of daily living, hospitalisation, emergency department visits, nursing home admissions or mortality. Risk of bias was appraised using the revised Cochrane risk-of-bias tool for randomized trials and ROBINS-I tool for non-randomized studies.
RESULTS
Nineteen studies were included studying a total of 22,168 patients. Core components of integrated care for multimorbid patients such as the involvement of a multidisciplinary team, high risk screening, tailored holistic assessment and an individualized care plan, were performed in a vast majority of the studies; however variability was observed in their operationalisation. Twenty-seven different patient, provider and service outcomes were reported, ranging from 1 to 13 per study. The meta-analyses could not demonstrate a beneficial impact on any of the predefined outcomes. Most included studies were of high risk for several biases.
CONCLUSION
The summarized evidence on nurse-led integrated care models in home-dwelling older people is inconclusive and of low quality. Future studies should include key components of implementation research, such as context analyses, process evaluations and proximal outcomes, to strengthen the evidence-base of nurse-led integrated care.
Integrated care models are highly recommended to overcome care fragmentation in the multimorbid older population. Nurses are potentially ideally situated to fulfil the role as care coordinator to guide integrated care. No systematic review has been conducted specifically focusing on the impact of nurse-led integrated care models for older people in community settings.
OBJECTIVES
To identify core components of nurse-led integrated care models for the home-dwelling older population; to describe patient, service and process outcomes; and to evaluate the impact of these care models on quality of life, activities of daily living, hospitalisation, emergency department visits, nursing home admissions and mortality.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
English, Dutch, French, German and Spanish articles selected from PubMed and CINAHL, hand-search of reference lists of the included articles and grey literature.
REVIEW METHODS
A systematic search was conducted to identify prospective experimental or quasi-experimental studies detailing nurse-led integrated care models in the older home-dwelling population. Study characteristics and reported outcomes were tabulated. The core components of the models were mapped using the Sustainable intEgrated chronic care modeLs for multi-morbidity: delivery, FInancing, and performancE (SELFIE) framework. A random effects meta-analysis was conducted to study the overall effectiveness of the included care models on health-related quality of life, activities of daily living, hospitalisation, emergency department visits, nursing home admissions or mortality. Risk of bias was appraised using the revised Cochrane risk-of-bias tool for randomized trials and ROBINS-I tool for non-randomized studies.
RESULTS
Nineteen studies were included studying a total of 22,168 patients. Core components of integrated care for multimorbid patients such as the involvement of a multidisciplinary team, high risk screening, tailored holistic assessment and an individualized care plan, were performed in a vast majority of the studies; however variability was observed in their operationalisation. Twenty-seven different patient, provider and service outcomes were reported, ranging from 1 to 13 per study. The meta-analyses could not demonstrate a beneficial impact on any of the predefined outcomes. Most included studies were of high risk for several biases.
CONCLUSION
The summarized evidence on nurse-led integrated care models in home-dwelling older people is inconclusive and of low quality. Future studies should include key components of implementation research, such as context analyses, process evaluations and proximal outcomes, to strengthen the evidence-base of nurse-led integrated care.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.ijnurstu.2020.103552
- PMID 32200100
- Persistent URL
- https://sonar.ch/global/documents/299209
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