Methods: This study followed systematic review standards established by the Institute of Medicine. Search criteria were developed by an independent research librarian. These criteria were used to search databases such as PubMed, PSYCINFO to identify relevant articles. A modified content analysis approach was used to assess the CCMs for level of integration using an established conceptual framework. Forty articles were identified that described 49 models.
Results: Ten programs (20%) showed minimal collaboration without co-location, 24 programs (49%) were co-located, but showed only basic collaboration, 3 programs (6%) showed elements of both of these first two categories, and 12 programs (25%) had attained full integration. Telemedicine was a feature of 10 CCMs and 4 (40%) of these were rated at minimal collaboration, 4 (40%) were colocated but showed only basic collaboration, 1 program (20%) showed elements of both of these first two categories, and 1 program (10%) had attained full integration.
Conclusions: The study results suggest that efforts are needed to erase barriers that may impede the development of CCMs with a higher degree of integration, in order to reduce healthcare costs and improve outcomes. This study found that 70% of CCMs had only minimal or basic collaboration. These low levels of collaboration will make it difficult to understand whether the expected cost savings might occur. Efforts to reduce barriers are urgent, if these models are to be adopted and live up to their potential to improve services and reduce expenditures. In addition, further development of the conceptual framework may be needed to accommodate key differentiators (e.g., degree of co-location, business model) for a given CCM that may not move together across the integration level. The current rubric did not permit us to assess the impact of telemedicine, especially video-conferencing, and this point illustrates the fact that health information technology-facilitated consultation models do not fit well in the conceptual framework. The models, though successful, did not always result in working “teams” of clinicians.