People with only 2 or more mental health problems and no physical health condition.
People who receive end-of-life or palliative care.
People with a single long-term health condition.
People with a single long-term condition with an interest in comorbidity (eg, cancer comorbidities).
EPOC, effective practice and organisation of care; HABI, holistic assessment–based interventions; MLTC, multiple long-term conditions
We will consider reviews reporting on any type of comparator intervention, including context-specific standard, or usual care.
We will consider systematic reviews reporting on health outcomes important to people with MLTCs 25 and/or frailty. 26 Guided by a consensus-based, core set of outcomes for MLTCs (COSmm) 25 and frailty (FOCUS), 26 the primary outcomes of interest will be health-related quality of life, physical and cognitive function, mortality, unscheduled hospital admission (times/year), unscheduled care attendance (provider visits/year), and care home admission (yes/no), measured by validated instruments or any clinically meaningful metrics. Secondary outcomes will be adverse drug events, length of hospital stay (bed days/year), and “geriatric syndromes” (eg, frailty, falls, delirium). We will consider reviews reporting on key outcomes of interest assessed using validated measures, including i) health-related quality of life: EuroQol Five-Dimension (EQ-5D); Short Form Health Survey (SF-12 or SF-36); Global quality of life (WHOQOL-BREF); Assessment of Quality of Life (AQoL 8); ii) cognitive function: Mini-Mental State Exam (MMSE); General Practitioner Assessment of Cognition (GPCOG); Memory Impairment Screen (MIS); Mini-Cog TM ; and iii) physical function: Sheehan Disability Scale (SDS); Sherbrooke Postal Q; Frenchay Activities Index (FAI); Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL) Scales; Barthel’s Index (BI); PROMIS Physical Function. This list is not exhaustive and other validated measures of outcomes will also be considered.
We define a systematic review as a synthesis of evidence that has a clearly stated set of objectives with pre-defined eligibility criteria for study selection; an explicit, reproducible methodology; a systematic search to identify all studies meeting the eligibility criteria; an assessment of the validity of the findings of the included studies; and a systematic synthesis of the characteristics and findings of the included studies. We will include systematic reviews of various types (eg, integrative systematic reviews, mixed-methods systematic reviews, combined scoping and systematic intervention reviews), with or without meta-analyses, reporting on experimental and quasi-experimental study designs, such as randomized controlled trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series study designs. Based on the Cochrane Effective Practice and Organisation of Care (EPOC) group criteria, these study designs are acceptable for evaluating the effectiveness of organizational interventions. We will exclude systematic reviews that report only on observational study designs (eg, case series, individual case reports, descriptive cross-sectional studies, case-control studies, cohort studies) and pharmacological studies. We will also exclude narrative reviews without a formal systematic search, screening, quality appraisal, extraction, and synthesis of evidence, as well as systematic reviews reporting on qualitative or theoretical studies or published opinions only (see Table Table1 1 ).
This protocol was developed according to the JBI methodology for umbrella reviews, 27 the reporting guideline for overviews of reviews of health care interventions (PRIOR), 28 and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. 29 The protocol was registered with PROSPERO (CRD42022363217).
Systematic searches will be performed in MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL Plus (EBSCO), Scopus, ASSIA (ProQuest), Cochrane Library, and TRIP Medical Database for peer-reviewed literature published since 2010. The date limit is applied to capture the most recent and relevant intervention reviews, given that MLCTs and integrated holistic care are relatively new concepts in health care. The search strategy will apply subject terms and keywords relating to the target population and intervention. The search terms will be combined with the Scottish Intercollegiate Guidelines Network (SIGN) database-specific filters for systematic reviews, with no language restrictions for the search. An information specialist will be consulted to finalize the search strategy, which will be tailored to each database. A search strategy used in MEDLINE (Ovid) is provided in Appendix I . In addition, we will manually search the reference lists of included reviews for other eligible reviews.
The retrieved records will be imported to EndNote v20.3 (Clarivate Analytics, PA, USA) for de-duplication. The de-duplicated RIS file will be transferred into Covidence (Veritas Health Innovation, Melbourne, Australia) for screening. Two reviewers will independently screen the retrieved records against the inclusion criteria, initially based on the titles and abstracts, followed by full-text screening. At the full-text screening stage, only reviews in English will be included due to lack of resources and to time constraints. Reasons for the exclusion of full-text studies will be recorded. Disagreement between the 2 reviewers will be resolved by discussion or via a third reviewer. The search and screening results will be presented in a PRISMA flow diagram. 29
We will extract data using an adapted and piloted JBI data extraction tool 27 (see Appendix II ). Data will be extracted on i) systematic review characteristics (title, first author, country, year of publication, objective); ii) included populations (age, gender, number of conditions, definitions, and measures used); iii) search strategy; iv) complex interventions (names/types of interventions, country in which interventions were tested, intervention components, holistic assessment domains [if reported], who led assessments [if reported], type of controls, total sample sizes, number of meta-analyses); v) setting (community, hospital, or both); and vi) analysis, health outcomes (types/measures used), and results. For reviews with no meta-analysis, a summary of the authors’ primary interpretation of findings will be extracted. For meta-analyses, we will extract data on pooled effect sizes (eg, rate ratio, risk ratio, odds ratio for dichotomous data, and mean difference or standardized mean difference for continuous data), as well as the corresponding 95% CIs and P values. For integrative systematic reviews, mixed-methods systematic reviews, and combined scoping and systematic intervention reviews reporting on experimental and quasi-experimental study designs, we will extract data on pooled effect sizes, 95% CIs, P values, and/or a statement summarizing the authors’ primary interpretation of the results.
Systematic reviews exploring similar topics may have considerable overlap in included primary studies. We will create a citation matrix and calculate the corrected covered area (CCA) index to analyse the overlap in primary studies included in reviews. 30 Based on the guidance of Hennessy and Johnson (2020), 31 we will further examine the reasons for overlap based on CCA value (see Appendix III for details). The reviews with complete/near complete overlap will be examined for reasons of high overlap and considered for exclusion; higher quality (eg, Cochrane reviews) and/or most recent reviews (if ratings are similar) will be retained.
Methodological quality will be appraised by 2 reviewers using the JBI critical appraisal checklist for systematic reviews and research syntheses (CACSRRS). 27 The tool comprises 11 items evaluating: i) clarity of the review question; ii) appropriateness of the inclusion criteria; iii) appropriateness of the search strategy; iv) adequacy of sources and resources used to search for studies; v) appropriateness of appraisal criteria; vi) duplicate conduct of quality appraisal; vii) applications used to minimize errors in data extraction; viii) appropriateness of methods used to combine the studies; ix) assessment of publication bias; x) soundness of recommendations for policy and practice; and xi) appropriateness of proposed new research directions. The items are scored based on the checklist as “Y=met,” “N=not met,” “?=unclear,” and “NA=not applicable.”
The JBI CACSRRS tool is not intended to generate an overall score, and the rating of overall quality may be based on certain criteria being met. 27 We differentiated items 1–3 and 5–10 as critical domains (see Appendix IV ). Rating the confidence of review results will be based on weaknesses in critical domains, ranging from “high” (no or one non-critical weakness), “moderate” (more than one non-critical weakness), “low” (one critical flaw with or without non-critical weaknesses), and “critically low” (more than one critical flaw with or without non-critical weaknesses). The results of the critical appraisal will be reported in a table with an accompanying narrative. All studies will undergo data extraction and synthesis; however, depending on the overall results of the critical appraisal, sensitivity analyses may be performed to test the robustness of our conclusions.
The extracted data will be synthesized manually. The summary of findings will be presented in tabular format, with narrative descriptions and visual indications accompanying the tabulated results. Where possible, analysis will be stratified by setting. We will classify interventions using an existing taxonomy of health interventions (eg, EPOC) and use a stop light visual indicator to summarize the effectiveness of interventions. 27 We will collate the pooled estimates reported in each meta-analysis, providing narrative synthesis to these findings.
In summarizing findings across the reviews, we will use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) 32 principles for an overall assessment of the quality of evidence across the reviews for outcomes of interest. 27 The quality of evidence for a given outcome will be graded as high, moderate, or low based on the overall quality of the systematic reviews and risk of bias in primary studies as well as consistency of results in relation to an outcome (see Appendix V ).
This study is funded by the National Institute for Health and Care Research (NIHR) under its Artificial Intelligence for Multiple and Long-Term Conditions Programme (NIHR202639). The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care.
Ruth Jenkins, information specialist, for assistance with the search strategy.
SA, NL, AA, ML, LF, NM, SM, and BG conceptualized the umbrella review. BG, SM, NL, ML, and AA secured funding. SA and BG developed the search strategy. SA and BG developed the first draft of the manuscript. All co-authors contributed to the review and editing of the final manuscript.
Medline (ovid).
Search conducted on September 26, 2022, returning 1909 results.
1. Multimorbidity/ |
2. Chronic Disease/ |
3. Comorbidity/ |
4. (multimorbid* or multi-morbid* or chronic disease$ or comorbid* or co-morbid* or polymorbid* or poly-morbid* or multidisease* or multi-disease* or disease cluster* or multiple long-term condition* or multiple chronic disease$).tw. |
5. ((coocur* or co-ocur* or coexist* or co-exist* or multipl* or concord* or discord*) adj3 (disease$ or ill* or care or condition$ or disorder* or health* or symptom* or syndrom*)).tw. |
6. or/1-5 |
7. Frailty/ |
8. Frail Elderly/ |
9. Frailty Syndrome/ |
10. (frail* or frail* syndrome or geriatric* syndrom* or vulnerabil* or function*).tw. |
11. or/7-10 |
12. 6 or 11 |
13. Adult/ |
14. Young adult/ |
15. Middle aged/ |
16. Aged/ |
17. (adult* or young adult* or middle aged or old* or elder* or geriatric* or gerontol* or ageing or aged).tw. |
18. or/13-17 |
19. Needs assessment/ |
20. Geriatric assessment/ |
21. Risk Assessment/ |
22. Patient-centered Care/ |
23. Health Services/ |
24. health services for the aged/ |
25. Delivery of Health Care, Integrated/ |
26. ((holistic or whole or comprehens* or complet*) adj3 (assess* or evaluat* or consult* or manag*)).tw. |
27. ((integrat* or co-ordinat* or multidisciplin* or patient-centr* or person-centr*) adj2 (care or service$)).tw. |
28. ((geriatric or aged or elderly or old age) adj3 (assess* or evaluat* or consult*)).tw. |
29. (team$ adj2 (care or treat* or assess* or consult*)).tw. |
30. (multidiscipline* adj3 assess*).tw. |
31. or/19-30 |
32. Meta-Analysis as Topic/ |
33. meta analy$.tw. |
34. metaanaly$.tw. |
35. Meta-Analysis/ |
36. (systematic adj (review$1 or overview$1)).tw. |
37. exp Review Literature as Topic/ |
38. or/32-37 |
39. cochrane.ab. |
40. embase.ab. |
41. (psychlit or psyclit).ab. |
42. (psychinfo or psycinfo).ab. |
43. (cinahl or cinhal).ab. |
44. science citation index.ab. |
45. bids.ab. |
46. cancerlit.ab. |
47. or/39-46 |
48. reference list$.ab. |
49. bibliograph$.ab. |
50. hand-search$.ab. |
51. relevant journals.ab. |
52. manual search$.ab. |
53. or/48-52 |
54. selection criteria.ab. |
55. data extraction.ab |
56. 54 or 55 |
57. Review/ |
58. 56 and 57 |
59. Comment/ |
60. Letter/ |
61. Editorial/ |
62. animal/ |
63. human/ |
64. 62 not (62 and 63) |
65. or/59-61,64 |
66. 38 or 47 or 53 or 58 |
67. 66 not 65 |
68. 12 and 18 and 31 and 67 |
69. limit 68 to yr=“2010 -Current” |
Systematic review details | |
---|---|
Title | |
First author/year | |
Country | |
Objective | |
Age (mean, SD) | |
Gender | |
Number of conditions | |
Definitions/measures used | |
Total number of participants | |
Sources searched | |
Range (years) of included studies | |
Number of studies included | |
Type of studies included | |
Country of origin of included studies | |
Names | |
Types included in a meta-analysis | |
Intervention components | |
Holistic assessment domains (if reported) | |
Multidisciplinary teams/who led the assessments (if reported) | |
Type of controls | |
Total sample sizes | |
Number of meta-analyses | |
Setting/context | |
Methods of analysis | |
Outcomes assessed (measures used) | |
Results | |
Significance/direction | |
Heterogeneity | |
Step 1: create citation matrix (cm).
The citation matrix (CM) will allow for assessing the amount of overlap at the review level as opposed to the outcome level. The CM will list all primary studies ( r =rows) included for each review ( c =columns). The duplicate rows will be removed to ensure that a primary study appearing across reviews is noted in a line. The first occurrence of a primary study will be defined as an index publication (see Table A ).
Citation matrix
Review 1 | Review 2 | Review 3 | |
---|---|---|---|
Primary study 1 | x | x | |
Primary study 2 | x | x | |
Primary study 3 | x | x | |
Primary study 4 | x | x | x |
The overlap in studies across the matrix will be calculated based on the CCA method 30 by dividing the frequency of repeated occurrences of the index publication in other reviews by the product of index publications and reviews, reduced by the number of index publications (see below).
N is the number of included publications (irrespective of overlaps) in evidence synthesis (this is the sum of the ticked boxes in the citation matrix); r is the number of rows (number of index publications), and c is the number of columns (number of reviews).
The degree of overlap across the matrix can vary from 0–5% slight overlap, 6–10% moderate overlap, 11–15% high overlap, to>15% very high overlap. Depending on the CCA value, a decision tree developed by Hennessy and Johnson (2020) 31 will be used to guide our further steps.
The reviews with complete/near complete overlap will be examined for reasons of high overlap and considered for exclusion; higher quality (eg, Cochrane reviews) and/or most recent reviews (if ratings are similar) will be retained.
JBI critical appraisal checklist for systematic reviews and research syntheses
Reviewer: Author: | Date: Year: Record Number: | ||||
---|---|---|---|---|---|
Yes | No | Unclear | NA | ||
1 | Is the review question clearly and explicitly stated? | ||||
2 | Were the inclusion criteria appropriate for the review question? | ||||
3 | Was the search strategy appropriate? | ||||
4 | Were the sources and resources used to search for studies adequate? | ||||
5 | Were the criteria for appraising studies appropriate? | ||||
6 | Was critical appraisal conducted by 2 or more reviewers independently? | ||||
7 | Were there methods to minimize errors in data extraction? | ||||
8 | Were the methods used to combine studies appropriate? | ||||
9 | Was the likelihood of publication bias assessed? | ||||
10 | Were the recommendations for policy/and or practice supported by the reported data? | ||||
11 | Were the specific directives for new research appropriate? | ||||
High (no or one non-critical weakness) Moderate (more than one non-critical weakness) Low (one critical flaw with or without non-critical weaknesses) Critically low (more than one critical flaw with or without non-critical weaknesses) |
*Critical domains: Items 1–3, 5–10.
Quality of evidence | Criteria |
---|---|
High-quality evidence | One or more updated (published within the last 3 years), high-quality systematic reviews that are based on at least 2 high-quality primary studies with consistent results. |
Moderate-quality evidence | One or more updated (published within the last 3 years) systematic reviews of high or moderate quality, based on at least: |
Low-quality evidence | One or more systematic reviews of variable quality, based on: |
* Based on the GRADE principles.
The authors declare no conflict of interest.
IMAGES
COMMENTS
A case study is one of the most commonly used methodologies of social research. This article attempts to look into the various dimensions of a case study research strategy, the different epistemological strands which determine the particular case study type and approach adopted in the field, discusses the factors which can enhance the effectiveness of a case study research, and the debate ...
Purpose of case study methodology. Case study methodology is often used to develop an in-depth, holistic understanding of a specific phenomenon within a specified context. 11 It focuses on studying one or multiple cases over time and uses an in-depth analysis of multiple information sources. 16,17 It is ideal for situations including, but not limited to, exploring under-researched and real ...
Gummesson (1988) argues that an important advantage of case study research is the opportunity for a holistic view of the process: "The detailed observations entailed in the case study method enable us to study many different aspects, examine them in relation to each other, view the process within its total environment and also use the ...
Definitions of qualitative case study research. Case study research is an investigation and analysis of a single or collective case, intended to capture the complexity of the object of study (Stake, 1995).Qualitative case study research, as described by Stake (), draws together "naturalistic, holistic, ethnographic, phenomenological, and biographic research methods" in a bricoleur design ...
A crucial distinction must be made between holistic and embedded case studies (Yin, 1994, p. 41). A holistic case study is shaped by a thoroughly qualitative approach that relies on narrative, phenomenological descriptions. Themes and hypotheses may be important but should remain subordinate to the understanding of the case (Stake, 1976, p. 8 ...
Abstract. This chapter explores case study as a major approach to research and evaluation. After first noting various contexts in which case studies are commonly used, the chapter focuses on case study research directly Strengths and potential problematic issues are outlined and then key phases of the process.
McMaster University, West Hamilton, Ontario, Canada. Qualitative case study methodology prov ides tools for researchers to study. complex phenomena within their contexts. When the approach is ...
This chapter explores case study as a major approach to research and evaluation using primarily qualitative methods, as well as documentary sources, contemporaneous or historical. However, this is not the only way in which case study can be conceived. No one has a monopoly on the term. While sharing a focus on the singular in a particular context, case study has a wide variety of uses, not all ...
Defnition: A case study is a research method that involves an in-depth examination and analysis of a particular phenomenon or case, such as an individual, organization, community, event, or situation. It is a qualitative research approach that aims to provide a detailed and comprehensive understanding of the case being studied.
A case study is a research approach that is used to generate an in-depth, multi-faceted understanding of a complex issue in its real-life context. It is an established research design that is used extensively in a wide variety of disciplines, particularly in the social sciences. A case study can be defined in a variety of ways (Table 5 ), the ...
Although case studies have been discussed extensively in the literature, little has been written about the specific steps one may use to conduct case study research effectively (Gagnon, 2010; Hancock & Algozzine, 2016).Baskarada (2014) also emphasized the need to have a succinct guideline that can be practically followed as it is actually tough to execute a case study well in practice.
Learn how to conduct and analyze a case study as a qualitative research method. Download the PDF article from ResearchGate and explore related topics.
The objective of this paper is to highlight similarities and differences across various case study designs and to analyze their respective contributions to theory. Although different designs reveal some common underlying characteristics, a comparison of such case study research designs demonstrates that case study research incorporates different scientific goals and collection and analysis of ...
Volume 18, No. 1, Art. 19 - January 2017 . Case Study Research: Foundations and Methodological Orientations. Helena Harrison, Melanie Birks, Richard Franklin & Jane Mills. Abstract: Over the last forty years, case study research has undergone substantial methodological development.This evolution has resulted in a pragmatic, flexible research approach, capable of providing comprehensive in ...
Five elements of a research design: Identify data to be collected— define: 1. question: case studies most useful for answering how, why. 2. propositions, if any to help problematize your question (e.g., organizations collaborate because they derive mutual benefit).
conducted into an individual, group, or event to gain an understanding of. a real-life phenomenon. It is often. used in the social sciences and. humanities to explore complex issues. and to ...
The need for methodological development to address the most urgent challenges in health research has been well-documented. Many of the most pressing questions for public health research, where the focus is on system-level determinants [1, 2], and for health services research, where provisions typically vary across sites and are provided through interlocking networks of services [], require ...
A case study is a research approach that is used to generate an in-depth, multi-faceted understanding of a complex issue in its real-life context. It is an established research design that is used extensively in a wide variety of disciplines, particularly in the social sciences. A case study can be defined in a variety of ways (Table 5 ), the ...
Stake's book describes the "naturalistic, holistic, ethnographic, phenomenological, and biographic research methods" (Stake, 1995, p. xi) as the interpretive orientation of the study case approach. Sharan Merriam, the case study approach's third major contributor, expanded on the work of both Stake and Yin.
Case studies play a significant role in knowledge development across various disciplines. Analysis of cases provides an avenue for researchers to explore phenomena within their context based on the collected data. Analysis of qualitative data from case study research can contribute to knowledge development.
4 Tips for choosing between holistic and embedded. When deciding between a holistic or embedded case study for your research, it is important to be clear about your research purpose and question ...
During a final phase of analysis, data from each case were organized into matrices, or data displays, to facilitate the classic techniques of case study research: within-case and cross-case comparisons of similarities and differences, development of propositions for further testing, and additional evaluation of data relevance to the conceptual ...
The NICE guidelines specifically called for research evaluating the effectiveness of "holistic assessment and intervention," (p.19) reflecting that this is often a core component of complex interventions in this field but with variations in implementation modalities and other elements included. 13 Further, interventions targeting people ...