The Evidence-base for Using Ontologies and Semantic Integration Methodologies to Support Integrated Chronic Disease Management in Primary and Ambulatory Care: Realist Review

Summary Background: Most chronic diseases are managed in primary and ambulatory care. The chronic care model (CCM) suggests a wide range of community, technological, team and patient factors contribute to effective chronic disease management. Ontologies have the capability to enable formalised linkage of heterogeneous data sources as might be found across the elements of the CCM. Objective: To describe the evidence base for using ontologies and other semantic integration methods to support chronic disease management. Method: We reviewed the evidence-base for the use of ontologies and other semantic integration methods within and across the elements of the CCM. We report them using a realist review describing the context in which the mechanism was applied, and any outcome measures. Results: Most evidence was descriptive with an almost complete absence of empirical research and important gaps in the evidence-base. We found some use of ontologies and semantic integration methods for community support of the medical home and for care in the community. Ubiquitous information technology (IT) and other IT tools were deployed to support self-management support, use of shared registries, health behavioural models and knowledge discovery tools to improve delivery system design. Data quality issues restricted the use of clinical data; however there was an increased use of interoperable data and health system integration. Conclusions: Ontologies and semantic integration methods are emergent with limited evidence-base for their implementation. However, they have the potential to integrate the disparate community wide data sources to provide the information necessary for effective chronic disease management.

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Corrigendum to “Towards an ontology for data quality in integrated chronic disease management: A realist review of the literature” [Int. J. Med. Inform. 82 (2013) 10–24]

International Journal of Medical Informatics ◽

10.1016/j.ijmedinf.2012.12.007 ◽

2013 ◽

Vol 82 (2) ◽

pp. 139 ◽

Cited By ~ 4

Author(s):

S.T. Liaw ◽

A. Rahimi ◽

P. Ray ◽

J. Taggart ◽

S. Dennis ◽

...

Keyword(s):

Chronic Disease ◽

Disease Management ◽

Data Quality ◽

Chronic Disease Management ◽

Realist Review ◽

Review Of The Literature

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Understanding factors critical to the implementation of ehealth in chronic disease management: a realist review protocol

BMJ Open ◽

10.1136/bmjopen-2020-048250 ◽

2021 ◽

Vol 11 (7) ◽

pp. e048250

Author(s):

Nida Shahid ◽

Valeria E Rac ◽

Joanna Bielecki ◽

Whitney Berta

Keyword(s):

Chronic Disease ◽

Disease Management ◽

Chronic Disease Management ◽

Data Extraction ◽

Evidence Synthesis ◽

Grey Literature ◽

Complex Interventions ◽

Realist Review ◽

Chronic Obstructive ◽

Multiple Chronic Conditions

IntroductionCanadians are living longer, many with multiple chronic conditions. This population of older, frail Canadians continues to grow in size as do concurrent demands for community-based, outpatient and ambulatory models of care. Ideally, a multifaceted, proactive, planned and integrated care model includes ehealth. Although several factors are known to facilitate the implementation of ehealth in chronic disease management (CDM), for example, adequate support, usability, alignment of programme objectives, there is a growing body of inconclusive evidence on what is critical for implementation. We aim to achieve a fulsome understanding of factors critical to implementation by conducting a realist review—an approach suitable for understanding complex interventions. Our proposed review will identify factors critical to the implementation of ehealth in CDM (heart failure, chronic obstructive pulmonary disease, chronic kidney disease and/or diabetes (type 1 or 2)) without limitations to care setting, language, publication year or geography. Findings will be presented in configurations of contexts, mechanisms and outcomes (CMOs).Methods and analysisA search strategy will be iteratively developed based on the concepts of ‘implementation’ and ‘adoption’ of ‘ehealth’ interventions used within ‘CDM’ to identify the peer-reviewed and grey literature published before 31 March 2021 from five databases (Medline, Embase, Cochrane, CINAHL and PsychInfo) on ehealth interventions actively involving a healthcare provider for CDM among adults. Data extraction and synthesis will be guided by Realist and Meta-review Evidence Synthesis: Evolving Standards (RAMESES) guidelines informing core concepts of CMOs, and a study output will include a middle-range-theory describing the implementation of ehealth in CDM.Ethics and disseminationFindings will be published in an open-access peer-reviewed journal and presented at relevant conferences. A multistakeholder (patients, caregivers, healthcare providers and practitioners, decision-makers and policy-makers) perspective will be used in our dissemination approach. No formal ethics approval is required for this review.PROSPERO registration numberCRD42020208275.

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Increasing the Involvement of Specialist Physicians in Chronic Disease Management

Journal of Health Services Research & Policy ◽

10.1258/jhsrp.2007.007068 ◽

2008 ◽

Vol 13 (1_suppl) ◽

pp. 52-56 ◽

Cited By ~ 4

Author(s):

Dylan Taylor ◽

Michele Lahey

Keyword(s):

Chronic Disease ◽

Disease Management ◽

Ambulatory Care ◽

Chronic Care Model ◽

Chronic Care ◽

Chronic Disease Management ◽

Care Delivery ◽

Multidisciplinary Teams ◽

Outpatient Services ◽

Care Model

Background The Capital Health (CH) region in Alberta serves the population of the Edmonton area as well as a large referral population in western Canada. CH is responsible for the delivery of the spectrum of patient care, from inpatient to outpatient services. Growth in outpatient care, in particular, has led to the development of several ambulatory care facilities from which the delivery of care to several populations with a chronic disease will be coordinated. Assessment of problem The traditional model of care delivery is unsuited to the management of chronic diseases. Physicians must be part of the planning and implementation of new models if they are to be successful and sustainable. The concept of integration into a delivery team is not well understood or practised. This is not conducive to the integration of specialist physicians into multidisciplinary teams in ambulatory care that serves the needs of patients from a large geographic area. Results Chronic disease management using the Chronic Care Model has proven to be an effective method of delivering care to this wide population. Specialist physicians have not always taken advantage of opportunities to be involved in the planning and development of such new health care projects. In CH, physician integration in the planning, development and implementation of this new model has proven vital to its success. Strategies for change We based our strategy for change on Wagner's Chronic Care Model. This involved eight steps, the first four of which have been completed and the fifth and sixth are underway. Lessons and messages Five factors contributed to the successful integration of specialist physicians in chronic disease management: collaboration between disciplines and organizations; creating patient-centred services; organizational commitments; strong clinical leadership; and early involvement of clinicians.

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