TY - JOUR
T1 - Integrated Care in Parkinson's Disease
T2 - A Systematic Review and Meta-Analysis
AU - Rajan, Roopa
AU - Brennan, Laura
AU - Bloem, Bastiaan R.
AU - Dahodwala, Nabila
AU - Gardner, Joan
AU - Goldman, Jennifer G.
AU - Grimes, David A.
AU - Iansek, Robert
AU - Kovács, Norbert
AU - McGinley, Jennifer
AU - Parashos, Sotirios A.
AU - Piemonte, Maria E.P.
AU - Eggers, Carsten
N1 - Funding Information:
Dr. Rajan receives research grant support from the DST‐SERB, DBT, Michael J. Fox Foundation, and All India Institute of Medical Sciences, New Delhi. Dr. Brennan is employed at Genomind and has received consultation fees from Eli Lilly and Signant Health. Prof. Bloem currently serves as associate editor for the ', serves on the editorial of and , has received honoraria from serving on the scientific advisory board for AbbVie, Biogen, and UCB, has received fees for speaking at conferences from AbbVie, Zambon, Roche, GE Healthcare, and Bial, and has received research support from the Netherlands Organization for Scientific Research, the Michael J. Fox Foundation, UCB, AbbVie, the Stichting Parkinson Fonds, the Hersenstichting Nederland, the Parkinson's Foundation, Verily Life Sciences, Horizon 2020, the Topsector Life Sciences and Health, the Gatsby Foundation, and the Parkinson Vereniging. Dr. Dahodwala has received support from AbbVie (research grant); Roche, Ely Lilly, and Cala Health (clinical trial site investigator); and Acadia (scientific advisory board). Dr. Goldman has received research support from Michael J. Fox Foundation, Parkinson's Foundation; consulting fees from Acadia, Sunovion, Worldwide Med and honoraria from American Academy of Neurology, International Parkinson Disease and Movement Disorder Society, and Parkinson's Foundation. Dr. Grimes has received honorariu, for consulting from the Department of Justice Canada/Government of Canada; clinical trials funding from CIHR, Civitas Therapeutics, Biotie Therapies, and grant funding from CIHR, Parkinson Canada, Ontario Brain Institute, PSI Foundation, Parkinson Research Consortium, uOBMRI. Prof. Kovacs received consultation fees from Hungarian subsidiaries of Medtronic, Abbott, Boston Scientific,. UCB, Krka, and AbbVie. N.K. is supported by the Hungarian Brain Research Program (2017‐1.2.1‐NKP‐2017‐00002), NKFIH EFOP‐3.6.2‐16‐2017‐00008, and NKFIH SNN125143 government‐based funds, and the Higher Education Institutional Excellence Programme of the Ministry for Innovation and Technology in Hungary, within the framework of the 5. thematic programs of the University of Pécs. Prof. Iansek has received funding from AbbVie Pharmaceuticals. Dr. Parashos has served as a scientific adviser for DongA and has received research support from AbbVie, DongA, Pharma2B, Impax, Theravance, and Park Nicolet Foundation. Prof. Eggers received payments as a consultant for AbbVie Inc. C.E. received honoraria as a speaker from AbbVie Inc., Daiichi Sankyo Inc., Bayer Vital Inc. C.E. received payments as a consultant for AbbVie Inc. and Philyra Inc. Journal of Parkinson s Disease Practical Neurology Digital Biomarkers
Publisher Copyright:
© 2020 The Authors. Movement Disorders published by Wiley Periodicals, LLC. on behalf of International Parkinson and Movement Disorder Society.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Background: Quality of life in Parkinson's disease (PD) is affected by motor and nonmotor symptoms, necessitating an integrated care approach. Existing care models vary considerably in numerous domains. The objectives of this study were to perform a systematic review and meta-analysis of PD integrated care models and develop recommendations for a representative model. Methods: We conducted a systematic review of published integrated care models and a meta-analysis of randomized, controlled trials examining integrated care versus standard care. The primary outcome was health-related quality of life using a validated PD scale. We evaluated levels of care integration using the Rainbow Model of Integrated Care. Results: Forty-eight publications were identified, including 8 randomized, controlled trials with health-related quality of life data (n = 1,149 total PD patients). Qualitative evaluation of individual care model integration guided by the Rainbow Model of Integrated Care revealed frequent clinical and professional integration, but infrequent organizational and population-based integration elements. Meta-analysis of randomized, controlled trials revealed significant heterogeneity (I2 = 90%, P ' 0.0001). Subgroup analysis including only outpatient care models (n = 5) indicated homogeneity of effects (I2 = 0%, P = 0.52) and improved health-related quality of life favoring integrated care, with a small effect size (standardized mean difference [SMD], −0.17; 95% CI, −0.31 to −0.03; P = 0.02). Conclusions: Outpatient integrated PD care models may improve patient-reported health-related quality of life compared with standard care; however, because of variable methodological approaches and a high risk of bias related to inherent difficulties in study design (eg, blinding of participants and interventionists), generalizability of these results are difficult to establish. The Rainbow Model of Integrated Care is a promising method of evaluating elements and levels of integration from individual patient care to population health in a PD context.
AB - Background: Quality of life in Parkinson's disease (PD) is affected by motor and nonmotor symptoms, necessitating an integrated care approach. Existing care models vary considerably in numerous domains. The objectives of this study were to perform a systematic review and meta-analysis of PD integrated care models and develop recommendations for a representative model. Methods: We conducted a systematic review of published integrated care models and a meta-analysis of randomized, controlled trials examining integrated care versus standard care. The primary outcome was health-related quality of life using a validated PD scale. We evaluated levels of care integration using the Rainbow Model of Integrated Care. Results: Forty-eight publications were identified, including 8 randomized, controlled trials with health-related quality of life data (n = 1,149 total PD patients). Qualitative evaluation of individual care model integration guided by the Rainbow Model of Integrated Care revealed frequent clinical and professional integration, but infrequent organizational and population-based integration elements. Meta-analysis of randomized, controlled trials revealed significant heterogeneity (I2 = 90%, P ' 0.0001). Subgroup analysis including only outpatient care models (n = 5) indicated homogeneity of effects (I2 = 0%, P = 0.52) and improved health-related quality of life favoring integrated care, with a small effect size (standardized mean difference [SMD], −0.17; 95% CI, −0.31 to −0.03; P = 0.02). Conclusions: Outpatient integrated PD care models may improve patient-reported health-related quality of life compared with standard care; however, because of variable methodological approaches and a high risk of bias related to inherent difficulties in study design (eg, blinding of participants and interventionists), generalizability of these results are difficult to establish. The Rainbow Model of Integrated Care is a promising method of evaluating elements and levels of integration from individual patient care to population health in a PD context.
KW - Parkinson's disease
KW - integrated care
KW - meta-analysis
KW - multidisciplinary team
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U2 - 10.1002/mds.28097
DO - 10.1002/mds.28097
M3 - Review article
C2 - 32598094
AN - SCOPUS:85087213370
SN - 0885-3185
VL - 35
SP - 1509
EP - 1531
JO - Movement Disorders
JF - Movement Disorders
IS - 9
ER -