Elements of integrated care models for children and adolescents with chronic diseases – Systematic cross-diagnosis review and analysis of transferability

The prevalence of chronic diseases in childhood and adolescence increases constantly. While the five most common chronic diseases in adults account for more than 50% of all cases, the incidence of chronic diseases in children and adolescents is much more widespread. Hence, apart from challenges related to the younger age and on-going development, chronic diseases among children and adolescents are much more heterogenous and therefore, are more challenging for health service provision. In addition, a higher burden due to greater intersectoral care needs (e.g. social or youth services) exists, impacting daily lives of patients and families. In order to avoid negative health consequences, reduce stress and enable good social participation, the provision of health care should thus work seamlessly across all sectors and disciplines. Integrated care (IC) offers a suitable solution for this, but has only been implemented to a limited extent in child health care so far. Furthermore, many models of IC focus on individual diseases only, e.g. asthma, and do not follow a broader, cross-diagnosis approach. Therefore, the aim of this study is to provide a systematic review of models of IC for children with a broad range of chronic diseases, to identify and systematically categorize joint elements of these models and assess their effectiveness and transferability to the German context. Methods: PubMed, Embase, PsycINFO, CINAHL and the Cochrane databases were searched for relevant studies (RCTs, CTs, systematic reviews and cohort studies) using PICO-scheme. Studies were screened for eligibility independently by at least two reviewers in a two-stage process (1) titles and abstracts, 2) full texts). The included studies are currently undergoing critical appraisal using established frameworks such as GRADE and CASP. Through a narrative synthesis, joint model elements will then be identified, categorised, with their effectiveness potentially assessed by meta-analyses. Finally, the transferability of the models into the German context will be analysed using a transferability assessment (e.g. FITAR) Patient representatives are involved as part of an interdisciplinary advisory board. Results: The results will comprise 1) a systematic overview of models of IC for children and adolescents with chronic diseases, 2) a categorisation of joint elements of these models that might be effective across diagnoses and 3) a systematic analysis of transferability. For example, a joint effective element of IC identified in different diagnosis-specific models could be the implementation of a coordinating case manager. Hence, the transferability of case managers as part of a cross-diagnosis model of IC will be assessed for the German context. Discussion: The heterogeneity of chronic diseases among children and adolescents often leads to the development of diagnosis-specific IC models. The current study thus enables for the first time an understanding of IC models and effective elements that allow cross-diagnosis application. This evidence is required to build cross-diagnosis IC models, which at the same time might be more efficient and simple to implement in different contexts due to their common base. The resulting broader usability and easier implementation might boost IC for children with chronic diseases.