TY - JOUR T1 - Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis JF - Canadian Medical Association Journal JO - CMAJ SP - E568 LP - E578 DO - 10.1503/cmaj.140289 VL - 186 IS - 15 AU - Andrea C. Tricco AU - Jesmin Antony AU - Noah M. Ivers AU - Huda M. Ashoor AU - Paul A. Khan AU - Erik Blondal AU - Marco Ghassemi AU - Heather MacDonald AU - Maggie H. Chen AU - Lianne Kark Ezer AU - Sharon E. Straus Y1 - 2014/10/21 UR - http://www.cmaj.ca/content/186/15/E568.abstract N2 - Background: Frequent users of health care services are a relatively small group of patients who account for a disproportionately large amount of health care utilization. We conducted a meta-analysis of the effectiveness of interventions to improve the coordination of care to reduce health care utilization in this patient group.Methods: We searched MEDLINE, Embase and the Cochrane Library from inception until May 2014 for randomized clinical trials (RCTs) assessing quality improvement strategies for the coordination of care of frequent users of the health care system. Articles were screened, and data abstracted and appraised for quality by 2 reviewers, independently. Random effects meta-analyses were conducted.Results: We identified 36 RCTs and 14 companion reports (total 7494 patients). Significantly fewer patients in the intervention group than in the control group were admitted to hospital (relative risk [RR] 0.81, 95% confidence interval [CI] 0.72–0.91). In subgroup analyses, a similar effect was observed among patients with chronic medical conditions other than mental illness, but not among patients with mental illness. In addition, significantly fewer patients 65 years and older in the intervention group than in the control group visited emergency departments (RR 0.69, 95% CI 0.54–0.89).Interpretation: We found that quality improvement strategies for coordination of care reduced hospital admissions among patients with chronic conditions other than mental illness and reduced emergency department visits among older patients. Our results may help clinicians and policy-makers reduce utilization through the use of strategies that target the system (team changes, case management) and the patient (promotion of self-management).See related commentary, www.cmaj.ca/lookup/doi/10.1503/cmaj.141050 ARTICLE ER -