1009 — Systematic Review and Meta-Analysis of Collaborative Chronic Care Models for Mental Health Conditions
Bauer MS (COLMR), Woltmann E
(COE-Ann Arbor), Grogan-Kaylor A
(University of Michigan), Perron BE
(University of Michigan), Georges H
(COLMR), Kilbourne AM
Collaborative chronic care models (CCMs) have been shown to improve outcome in chronic medical illnesses. CCMs, as articulated by Wagner and colleagues, are not a uniform intervention, but rather represent a flexible care model that includes several or all of: patient self-management support, clinical information systems, delivery system redesign, decision support, health care organization support, and linkage to community resources. CCMs have been widely studied in depression treated in primary care, with a growing number of trials for other mental disorders. However, effects on mental health conditions have not been comprehensively assessed.
CCMs were defined a priori as interventions having at least 3 out of 6 of the above components, excluding interventions with mobile treatment teams. Randomized controlled trials of CCMs vs. other care conditions published or in press through 12/1/09 were identified via MEDLINE, PsychINFO, EMBASE, SCOPUS, the Cochrane database, and www.clinicaltrials.gov, supplemented by contact with investigators in the area. Trials were included in the systematic review if primary or secondary analysis for any sample included: mental health clinical symptoms, social role function, or mental quality of life. Meta-analyses included reports of unadjusted continuous measures, and applied random effects models to estimate average CCM effect vs. control.
Systematic review yielded 1,642 articles from which 41 qualifying trials were identified; these trials produced 60 articles with non-redundant analyses. The majority of trials studied depression (n = 28), but more recent trials also addressed bipolar disorder (n = 4), anxiety disorders (n = 3), or multiple (n = 4) or other (n = 2) mental disorders. Systematic review methods demonstrated beneficial CCM effects on clinical, functional, and quality of life outcomes at no to modest net cost. As an example of meta-analysis results, 12 studies met criteria for depressive symptom meta-analysis. CCMs were associated with 0.28 standard deviation reduction (95%CI = -0.41, -0.15) in depressive symptoms compared to control.
CCMs improve a broad range of outcome domains for various mental health conditions, as has also been demonstrated for chronic medical illnesses.
CCMs represent an evidence-based model to improve outcome across a wide variety of mental health conditions. Adaptation to specific care venues and identification of optimal implementation strategies remain key challenges.