Chronic Care Model Decision Support and Clinical Information Systems Interventions for People Living with HIV: A Systematic Review
The Chronic Care Model is an effective framework for improving chronic disease management. There is scarce literature describing this model for people living with HIV. Decision Support (DS) and Clinical Information Systems (CIS) are two components of this model that aim to improve care by changing health care provider behavior.
Our aim was to assess the effectiveness of DS and CIS interventions for individuals with HIV, through a systematic literature review.
We performed systematic electronic searches from 1996 to February 2011 of the medical (E.g. Medline, EMBASE, CINAHL) and grey literature. Effectiveness was measured by the frequency of statistically significant outcome improvement. Data and key equity indicator extraction and synthesis was completed.
PARTICIPANTS AND INTERVENTIONS
We included comparative studies of people living with HIV that examined the impact of DS or CIS interventions on outcomes.
The following measures were assessed: outcome (immunological/virological, medical, psychosocial, economic measures) and health care process/performance measures.
Records were screened for relevance (n = 10,169), full-text copies of relevant studies were obtained (n = 123), and 16 studies were included in the review. Overall, 5/9 (55.6%) and 17/41 (41.5%) process measures and 5/12 (41.7%) and 3/9 (33.3%) outcome measures for DS and CIS interventions, respectively, were statistically significantly improved. DS–explicit mention of implementation of guidelines and CIS-reminders showed the most frequent improvement in outcomes. DS-only interventions were more effective than CIS-only interventions in improving both process and outcome measures. Clinical, statistical and methodological heterogeneity among studies precluded meta-analysis. Primary studies were methodologically weak and often included multifaceted interventions that made assessment of effectiveness challenging.
Overall, DS and CIS interventions may modestly improve care for people living with HIV, having a greater impact on process measures compared to outcome measures. These interventions should be considered as part of strategies to improve HIV care through changing provider performance.
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- Chronic Care Model Decision Support and Clinical Information Systems Interventions for People Living with HIV: A Systematic Review
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Journal of General Internal Medicine
Volume 28, Issue 1 , pp 127-135
- Cover Date
- Print ISSN
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- chronic disease management
- Chronic Care Model
- decision support
- clinical information systems
- practice guidelines
- systematic review
- Industry Sectors
- Author Affiliations
- 1. Faculty of Medicine, University of Ottawa, Ottawa, Canada
- 2. C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, Canada
- 3. Ottawa Hospital Research Institute, Ottawa, Canada
- 4. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
- 5. Centre for Public Health Excellence, National Institute for Health and Clinical Excellence, Manchester, UK
- 6. Ontario HIV Treatment Network, Toronto, Canada
- 7. Department of Psychiatry, University of Toronto, Toronto, Canada
- 8. Centre for Research on Inner City Health in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada
- 9. Department of Family Medicine, University of Ottawa, Ottawa, Canada