Integrated care for children found to improve quality of life and reduce costs

1. A meta-analysis of 23 randomized controlled trials examining the impact of integrated care interventions on health-related outcomes in children 0-18 years of age showed significantly improved quality of life in meta-analysis among children receiving integrated care interventions.

2. Evaluation of emergency department (ED) visits did not show a significant difference between groups. Cost savings were reported in a majority of studies that examined cost outcomes.

Evidence Rating Level: 2 (Good)

Study Rundown: Models of integrated care have been developed in an attempt to improve care, quality of life, reduce ED visits, and more. While the effectiveness of integrated care interventions for specific conditions among children has been studied, there has not been a comprehensive review of broad, population-based integrated care interventions for children. In this meta-analysis, researchers examined 23 randomized controlled trials studying the impact of integrated care interventions on a variety of health outcomes in children 18 years of age and younger. Investigators found that, when compared with control groups, integrated care interventions significantly improved quality of life at 6-month follow-up, but did not significantly reduce ED visits. The majority of studies examining cost outcomes found that integrated care interventions were associated with cost savings.

These findings are limited by the heterogeneity of outcomes of included studies, which prevented analysis of study data in all but two outcome domains. Furthermore, researchers were unable to determine the extent of integration in the interventions studied. Nonetheless, the study is strengthened by its thorough evaluation of the current body of literature on emerging integrated care interventions. For physicians, these findings highlight the potential health benefits and cost savings for patients from implementing integrated care interventions.

In-Depth [systematic review and meta-analysis]: Researchers used publication databases to identify 23 studies examining the impact of integrated care interventions for children 0-18 years old with ongoing health conditions on health-related outcomes. Only randomized controlled trials published between 1990 and 2018 were included. Studies were reviewed and meta-analysis was conducted for rates of ED visits and child-related quality of life measures across studies. Meta-analysis for other measures was not possible due to data heterogeneity. Studies were analyzed for risk of bias using Cochrane’s risk of bias tool for randomized trials.

Meta-analysis of integrated care interventions revealed that interventions had a significant effect on improving quality of life scores over usual care at 6-month follow-up (standardized mean difference [SMDs] =0.24; 95% confidence interval [CI] 0.03-0.44). Integrated care interventions did not significantly reduce ED visits compared with control groups (odds ratio [OR] = 0.88; 95% CI 0.57-1.37). Of the 4 interventions studied for cost savings outcomes, 3 showed overall cost savings when compared to the control. The quality of evidence overall was moderate, with a large portion of studies at low to moderate risk of bias.