Muhamad Y Elrashidi1, Khaled Mohammed2, Pavithra R Bora3, Qusay Haydour4, Wigdan Farah5, Ramona DeJesus6, Mohammad Hassan Murad7, Jon O Ebbert8. 1. Mayo Clinic, Primary Care Internal Medicine, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: elrashidi.muhamad@mayo.edu. 2. Mayo Clinic, Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: Mohammed.Khaled@mayo.edu. 3. Mayo Clinic, Knowledge and Evaluation Research Unit, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: bora819@gmail.com. 4. Augusta University, Internal Medicine Department, 1120 15th St, Augusta, GA 30912, USA. Electronic address: qhaydour@augusta.edu. 5. Mayo Clinic, Preventive Medicine, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: Farah.Wigdan@mayo.edu. 6. Mayo Clinic, Primary Care Internal Medicine, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: DeJesus.Ramona@mayo.edu. 7. Mayo Clinic, Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: Murad.Mohammad@mayo.edu. 8. Mayo Clinic, Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: Ebbert.Jon@mayo.edu.
Abstract
BACKGROUND: Co-location of specialists in primary care has been suggested as an approach to reduce care fragmentation, inefficiency, and cost. We conducted a systematic review and meta-analysis evaluating the impact of co-located specialty care models in primary care settings. METHODS: Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus was conducted through February 2015. A manual search of the included studies' bibliographies was conducted. Randomized controlled trials (RCTs) and observational studies reporting physically co-located specialties in primary care on the following outcomes were included: patient satisfaction; provider satisfaction; health care access and utilization; clinical outcomes, and costs. RESULTS: Of 1620 articles, 22 studies met inclusion criteria, including 9 RCTs and 13 observational studies. Co-located care was observed to be associated with increased patient satisfaction (OR 2.04; 95% CI 1.04-3.98), primary care provider satisfaction (OR 6.49, 95% CI 4.28-9.85), and outpatient visits (OR 1.94; 95% CI 1.13-3.33). Co-located care was associated with reduced appointment wait time (OR 0.20, 95%CI 0.10 - 0.41). Reduced costs and improvement in quality of life and selected diabetes related outcomes were also observed. Evidence quality was limited by few studies, high risk of bias, and heterogeneity. CONCLUSIONS: Co-located specialty care in primary care settings may support the aims of high value care delivery. However, additional studies are needed to further evaluate the value of co-location of specific specialties and stronger data on impact to health outcomes and cost.
BACKGROUND: Co-location of specialists in primary care has been suggested as an approach to reduce care fragmentation, inefficiency, and cost. We conducted a systematic review and meta-analysis evaluating the impact of co-located specialty care models in primary care settings. METHODS: Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus was conducted through February 2015. A manual search of the included studies' bibliographies was conducted. Randomized controlled trials (RCTs) and observational studies reporting physically co-located specialties in primary care on the following outcomes were included: patient satisfaction; provider satisfaction; health care access and utilization; clinical outcomes, and costs. RESULTS: Of 1620 articles, 22 studies met inclusion criteria, including 9 RCTs and 13 observational studies. Co-located care was observed to be associated with increased patient satisfaction (OR 2.04; 95% CI 1.04-3.98), primary care provider satisfaction (OR 6.49, 95% CI 4.28-9.85), and outpatient visits (OR 1.94; 95% CI 1.13-3.33). Co-located care was associated with reduced appointment wait time (OR 0.20, 95%CI 0.10 - 0.41). Reduced costs and improvement in quality of life and selected diabetes related outcomes were also observed. Evidence quality was limited by few studies, high risk of bias, and heterogeneity. CONCLUSIONS: Co-located specialty care in primary care settings may support the aims of high value care delivery. However, additional studies are needed to further evaluate the value of co-location of specific specialties and stronger data on impact to health outcomes and cost.
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