Table 1.
Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessment of randomised controlled trials reporting effectiveness of patient-centred medical home (PCMH) vs. standard general practitioner (GP) care on outcomes of interest.
| Outcomes | No of Studies | Risk of Bias | Inconsistency | Indirectness | Imprecision | Publication Bias | GRADE Quality of Evidence þ |
|---|---|---|---|---|---|---|---|
| Depression | 31 | Serious | Serious | Not serious | Not serious | Undetected | Moderate ‡ |
| Quality of Life | 21 | Serious | Not serious | Not serious | Not serious | Undetected | Moderate ‡ |
| Blood pressure | 13 | Serious | Not serious | Not serious | Not serious | Undetected | Moderate ‡ |
| Glycated Hemoglobin | 9 | Serious | Serious | Not serious | Not serious | Undetected | Low ঠ|
| LDL Cholesterol | 4 | Serious | Serious | Not serious | Not serious | Undetected | Low ঠ|
| HDL Cholesterol | 1 | Serious | - | Not serious | Not serious | Undetected | Low †‡^ |
| Total Cholesterol | 2 | Serious | - | Not serious | Not serious | Undetected | Low ‡^ |
| Hospital admissions | 5 | Serious | Not serious | Not serious | Not serious | Undetected | Moderate ‡ |
| Self-management (PACIC scores) | 3 | Serious | Serious | Not serious | Not serious | Undetected | Low ঠ|
| Cost-effectiveness | 19 | Serious | Serious | Not serious | Not serious | Undetected | Low ঠ|
þ High quality: Further research is very unlikely to change our confidence in the estimate of effect; Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; Very low quality: We are very uncertain about the estimate; LDL—Low Density Lipoprotein; HDL—High Density Lipoprotein; PACIC—Patient Assessment of Care for Chronic Conditions; ‡ Most studies did not blind participants or personnel as it was not practical. Therefore, we did not downgrade for these risks/uncertainties. However, studies not reporting blinding of outcome assessment were downgraded in quality; ¶ Significant level of heterogeneity within results (I2 between 80–90%); ^ Single study—Inconsistency not applicable; † Because of the nature of the quasi-experimental designs risk of bias is unavoidable.