If future research is to adequately inform practice and policy regarding the impact of these efforts on health outcomes, focus on the actual relationships between context, mechanisms and outcomes should be actively incorporated into study designs. It is likely that investments at the social context level will also help to decrease the development of barriers at the organisational context level, especially by increasing staff involvement and satisfaction. ConclusionsĮfficient resource allocation should entail increased investments at the organisational context level where most barriers are expected to occur. Due to the low number of articles reporting comparable quantitative outcome measures or in-depth qualitative information, it was not possible to make statements about the relationship between context, mechanisms and outcomes. Most reported barriers to the implementation process were found at the organisational context level and most facilitators at the social context level.
Thirty-two studies met the inclusion criteria. The CMO model (context + mechanism = outcome) was used to study the relationship between context factors (described by the barriers and facilitators encountered in the implementation process and categorised at the six levels of the Implementation Model), mechanisms (defined as intervention types and described by their number of Chronic Care Model (sub-)components) and outcomes (the intentional and unintentional effects triggered by mechanism and context). The quality of the studies was assessed with the Mixed Methods Appraisal Tool. Data extraction was performed using a common data extraction table. Articles were included when they focussed on integrated care and type 2 diabetes, and concerned empirical research analysing the implementation of an intervention. This study aims to answer the following two research questions: First, what are the context, mechanisms and outcomes of integrated care for people with type 2 diabetes? Second, what are the relationships between context, mechanisms and outcomes of integrated care for people with type 2 diabetes? MethodsĪ systematic literature search was conducted for the period 2003–2013 in Cochrane and PubMed. Integrated care interventions for chronic conditions can lead to improved outcomes, but it is not clear when and why this is the case.
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