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The authors declare that they have no competing interests.
MHM and JSE had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. MHM, VMM and NDS conceived and designed the study. SB, JRE and LJP acquired the data. MHM and JSE analyzed and interpreted the data. MHM and JSE drafted the manuscript. All authors critically revised the manuscript for important intellectual content. MHM, JSE and JLR provided administrative, technical, or material support. MHM supervised the study. All authors have given final approval for publication.
This systematic review and meta-analysis aims at assessing the composition and performance of care management models evaluated in the last decade and their impact on patient important outcomes.
A comprehensive literature search of electronic bibliographic databases was performed to identify care management trials in type 2 diabetes. Random effects meta-analysis was used when feasible to pool outcome measures.
Fifty-two studies were eligible. Most commonly reported were surrogate outcomes (such as HbA1c and LDL), followed by process measures (clinic visit or testing frequency). Less frequently reported were quality of life, patient satisfaction, self-care, and healthcare utilization. Most care management modalities were carved out from primary care. Meta-analysis demonstrated a statistically significant but trivial reduction of HbA1c (weighted difference in means -0.21%, 95% confidence interval -0.40 to -0.03, p < .03) and LDL-cholesterol (weighted difference in means -3.38 mg/dL, 95% confidence interval -6.27 to -0.49, p < .02).
Most care management programs for patients with type 2 diabetes are 'carved-out', accomplish limited effects on metabolic outcomes, and have unknown effects on patient important outcomes. Comparative effectiveness research of different models of care management is needed to inform the design of medical homes for patients with chronic conditions.