Table 1. Characteristics of Included Studies in the Meta-analysis.
| Source | Study design | Setting | Total No.a | Age, mean (SD), y | Male, % | Duration, mo | Outcome measures | Team members (No. of professions in team)b | Main ICP team features or process (name of intervention program/model if specified OR other notable specifics)c |
|---|---|---|---|---|---|---|---|---|---|
| Randomized clinical trials | |||||||||
| Barceló et al,24 2010 Mexico | RCTd | Public health centers | 307 | Not reported | Not reported | 18 | HbA1ce | Physician; case management advisor nurse; nutritionist and psychologist (at some sites) (4) | Group educational sessions; colocation; visitation by case management advisor (before and after ACIC questionnaire adapted for diabetes)f,g |
| SBPe | |||||||||
| DBPe | |||||||||
| Cezaretto et al,25 2012 Brazil | RCTh | Public health system | 177 | I: 56.1 (11.4) | 32.2 | 9 | SBPe | Physician; endocrinologist; nutritionist; psychologist; physical educator (4) | Shared medical appointments and group visits; Biweekly meetings; colocation; face-to-face communication (psycho-educative sessions)f,g |
| C: 53.8 (13.3) | DBPe | ||||||||
| FBG | |||||||||
| Cohen et al,26 2011 United States | RCTh | Veterans Affairs Health System | 99 | I: 69.8 (10.7) | I: 100 | 6 | HbA1ce | Physician; dietitian; nurse; pharmacist; physical therapist (5) | CPA; joint group educational sessions; shared EMR; colocation; face-to-face communication (MEDIC-E)f,g,i,j,k |
| C: 67.2 (9.4) | C: 96 | SBPe | |||||||
| DePue et al,27 2013 American Samoa | RCTl | Community health center | 268 | 55 (12.7) | 38 | 12 | HbA1ce | Physician; CHW; nurse (3) | Medical chart; colocationf,k |
| SBPe | |||||||||
| DBPe | |||||||||
| Edelman et al,28 2010 United States | RCTh | Veterans Affairs Health System | 239 | I: 63.0 (9.4) | I: 95.5 | 12.8 | HbA1ce | Physician; nurse or certified diabetes educator; pharmacist (3) | Shared medical appointments and group visits; joint group educational sessions; colocation |
| C: 60.8 (10.0) | C: 96.2 | SBPe | |||||||
| DBPe | |||||||||
| Goyer et al,29 2013 Canada | RCTh | Specialized clinic | 185 | 54.4 (8.6) | I: 64.5 | 24 | HbA1ce | Physician; kinesiologist; nurse; nutritionist; CV prevention specialist; psychologist (6) | Shared medical appointments or group visits; biweekly meetings; colocation; face-to-face communicationf,g |
| SBPe | |||||||||
| C: 71 | DBPe | ||||||||
| ASCVD risk | |||||||||
| Liou et al,30 2014 Taiwan | RCTh | Community health center in underserved areas | 95 | I: 56.6 (7.7) | I: 52 | 6 | HbA1ce | Physician; diabetes specialist; dietitian; nurse (4) | Shared medical appointments or group visits via interactive videoconferencef,g |
| C: 57.0 (7.5) | C: 49 | SBPe | |||||||
| DBPe | |||||||||
| Maislos and Weisman,31 2004 Israel | RCTh | Mobile clinic | 82 | I: 58 (14) | I: 24 | 6 | HbA1ce | Physician; diabetes specialist; dietitian; diabetes educator nurse (3) | Shared medical appointments; colocation; face-to-face communication; shared EMR; treatment protocolf,g,i,j,k |
| C: 63 (9) | C: 12 | ||||||||
| Pimazoni-Netto et al,32 2011 Brazil | RCTh | Ambulatory care clinic/center/office | 63 | I: 54.5 (1.7) | I: 28 | 3 | HbA1ce | Physician; diabetes educator; diabetes nurse; exercise trainer; psychologist (5) | Shared medical appointments; colocation; face-to-face communicationf,i,j |
| C: 58.4 (1.7) | C: 29 | ||||||||
| Ramli et al,33 2016 Malaysia | RCTd | Public ambulatory care clinics | 888 | I: 58 (0.5) | I: 38.2 | 12 | HbA1ce | Physician; dietitian; medical assistant; medical officer; nurse; nutritionist; pharmacist (7) | Joint or group educational sessions; colocation (EMPOWER-PAR)f,g,i,j,k |
| C: 57 (0.5) | C: 35.7 | SBPe | |||||||
| DBPe | |||||||||
| Siqueira-Catania et al,34 2013 Brazil | RCTh | Primary care center | 180 | 54.7 (12.3) | 35 | 9 | SBPe | Physician; nutritionist; psychologist; physical educator (4) | Joint or group educational sessions with patients; colocationf,g,j |
| DBPe | |||||||||
| Tang et al,35 2013 United States | RCTh | Nonprofit health care organization ambulatory care sites | 415 | I: 54 (10.7) | 58.9 | 12 | HbA1ce | Physician; dietitian; nurse case manager; pharmacist specialist; research assistant (5) | CPA; shared EMR; online messaging (use of wireless glucometers and uploading from home; personalized text and educational videos)f,g,i,j |
| SBPe | |||||||||
| C: 53.5 (10.2) | DBPe | ||||||||
| ASCVD risk | |||||||||
| Taveira et al,36 2010 United States | RCTh | Veteran Affairs Health System | 109 | I: 62.2 (10.3) | I: 91.4 | 4 | HbA1ce | Pharmacist (CDE); nurse; nutritionist; physical therapist (4) | Shared medical appointments and group visits; colocation (VA-MEDIC)f,g,i,j |
| C: 66.8 (10.2) | C: 100 | SBPe | |||||||
| DBPe | |||||||||
| Taylor et al,37 2005 Canada | RCTh | Ambulatory care clinic | 40 | I: 58 | I: 65 | 4 | HbA1ce | Physician; dietitian; exercise specialist; nurse care manager and educator (4) | Colocation; nurse worked in a collaborative manner as a case manager, educator, and support person (connecting, empowering, doing for, and finding meaning)f,g |
| SBPe | |||||||||
| C: 67 | C: 68 | DBPe | |||||||
| FBG | |||||||||
| Tourkmani, et al38 2018 Saudi Arabia | RCTh | Chronic diseases center specialized clinics | 289 | I: 56.9 (12) | I: 34.4 | 9 | HbA1ce | Senior family physician; clinical pharmacy specialist; dietitian; diabetes educator; health educator; social worker (6) | Weekly team meetings to review patient eligibility and care plans for those already enrolled; colocation; face-to-face communicationf,i,j,k |
| C: 57.5 (11.6) | C: 36.8 | SBPe | |||||||
| DBPe | |||||||||
| Prospective cohort studies | |||||||||
| Bray et al,39 2013 United States | Prospective cohort | Rural fee-for-service model | 727 | I: 59.5 (12) | 34 | 18m & 36 | HbA1ce | Physician; dietitian; nurse care manager; pharmacist (4) | Colocationf,i,j |
| C: 60.6 (12.4) | SBPe | ||||||||
| DBPe | |||||||||
| Cueto-Manzano et al,40 2013 Mexico | Prospective cohort | Family Medicine Unit - Mexican Institute of Social Security | 96 | I: 62 (11) | I: 53 | 6 | HbA1ce | Family physician; dietitian; physical trainer; social worker (4) | Group educational sessions for 2 h per week over 4 wk; colocationf,g |
| C: 61 (10) | C: 57 | SBPe | |||||||
| DBPe | |||||||||
| Jiao et al,41 2014 Hong Kong | Prospective cohort | Public general outpatient clinics | 2144 | I: 64.3 (10.9) | I: 49.8 | 12 | HbA1ce | Physician; advanced practice nurse; consultant in family medicine; dietitian; nurse; optometrist; podiatrist; physiotherapist (8) | Colocation (risk-stratified interventions)f,j |
| SBPe | |||||||||
| C: 65.3 (11.7) | C: 49.8 | DBPe | |||||||
| CV event | |||||||||
| Majumdar et al,42 2003 Canada | Prospective cohort | Ambulatory care clinic/center/office | 393 | I: 63.9 (12.7) | I: 48.7 | 6 | HbA1ce | Physician; dietitian; nurse diabetes educator; pharmacist; specialist (unspecified) (4) | Group IP educational sessions; monthly educational sessions by traveling team of specialist intervention team; colocation (specialist-to-rural primary care physicians academic detailing)f,j |
| C: 21 (12.4) | C: 37.6 | SBP | |||||||
| DBP | |||||||||
| Panattoni et al,43 2017 United States | Prospective cohort | Nonprofit multidisciplinary group clinics | 11 190 | I: 56.82 | I: 55.54 | 12 | HbA1c | Physician; health coach; nurse care manager; unlicensed medical assistant; pharmacist (5) | Joint or group IP educational sessions; shared EMR; colocation; face-to-face communication (champion standard work)f,g,i,j,k |
| C: 61.89 | C: 50.19 | SBPe | |||||||
| DBPe | |||||||||
| Parker et al,44 2016 United States | Prospective cohort | FQCHC | 120 | I: 52 (8) | I: 32 | Project: 36 | HbA1ce | Nurse practitioner/physician; registered nurse; students and faculty from optometry; pharmacist; nurse; health care administrator; physical therapist (7) | Face-to-face communication; joint or group educational sessions; team conferences, including an initial team assessment meeting |
| C: 52 (12) | C: 34 | Results: from 1 calendar year | |||||||
| Schouten et al,45 2010 the Netherlands | Prospective cohort | Ambulatory care clinics | 1861 | I: 66 (12.1) | I: 54.8 | 12 | HbA1ce | Physician; diabetes nurse; diabetes educator; dietitian; endocrinologist (4) | Joint or group IP educational sessions; consultant services from endocrinologist and diabetes educator; face-to-face communication (quality improvement collaborative)f,i |
| C: 67 (11.2) | C: 52.2 | SBPe | |||||||
| DBPe | |||||||||
| Retrospective cohort study | |||||||||
| Yu et al,46 2017 Hong Kong | Retrospective cohort | Public primary care clinics | 20 524 | I: 63.8 (9.6) | I: 43.6 | 12 | SBPe | Physician; dietitian; nurse; physiotherapist and/or occupational therapist (4 or 5) | Shared EMR; telecommunication/telemedicine; risk assessment and management plan with defined roles for each health care professional–referral process by the care managerg,j,k |
| C: 63.7 (10.0) | C: 43.7 | DBPe | |||||||
| Prospective pre-post studies | |||||||||
| Collier and Baker,47 2014 United States | Prospective pre-post | Veteran Affairs Health System | 138 | 64.1 (8.6) | Not reported | 3 | HbA1ce | Pharmacist (CDE); endocrinologist; health technician clerk; nurse educator; dietitian (5) | PCMH; colocation; shared EMR and CPA (PACT)j,k |
| Didier and Guimarães,48 2007 Brazil | Prospective pre-post | Health center outpatient service | 88 | 58.03 (9.90) | 22 | 12 | SBPe | Cardiologist; nurse; nursing technician; nutritionist; social assistant (4) | Joint or group IP educational sessions; shared medical appointments; colocationf,g,i,j,k |
| DBP | |||||||||
| Retrospective pre-post studies | |||||||||
| Al Asmary et al,49 2013 Saudi Arabia | Retrospective pre-post | Ambulatory care center | 41 | 56.2 (12.9) | 41.5 | 6 | HbA1ce | Physician; diabetes educator; dietitian; health educator; nurse; pharmacist specialist; social worker (7) | Weekly team meetings/rounds/huddles; colocationf,g,i,j,k |
| SBPe | |||||||||
| DBPe | |||||||||
| FBG | |||||||||
| BeLue et al,50 2014 United States | Retrospective pre-post | Community health center | 189 | 51 | 50 | 24 | HbA1ce | Family medicine physician; dentist; nutritionist; optometrist; psychologist (5) | Colocation, with some members contracted from local hospital/health center (EMPOWER-PAR)f,g,j |
| Chwastiak et al,51 2017 United States | Retrospective pre-post | Safety net clinic as part of an academic hospital | 634 | I: 53.6 (10.3) | I: 60.9 | 18 | HbA1ce | Primary care professional; care manager (filled by 2 registered nurses, an advanced practice nurse, and a registered dietitian CDE); medical consultant; medical assistant; psychiatric consultant (6) | Weekly caseload review; caseload tracked and maintained by medical assistant (care coordinators were coordinating with outside agencies, and specialist in substance abuse as needed)f,j,k |
| C: 54.7 (11.4) | C: 60.7 | SBP | |||||||
| Deichmann et al,52 2013 United States | Retrospective pre-post | Ochsner Medical Center Outpatient Internal Medicine Clinic | 216 | Not reported | Not reported | 6 | HbA1ce | Physician or nurse practitioner; dietitian; nurse/health coach; pharmacist (4) | Shared EMR; colocation |
| Health care professionals saw patients separately during a 2-h visit, 30 min for each rotation through the room | |||||||||
| Nurse coordinator managed the time and transition between health care professionals | |||||||||
| Farrell et al,53 2013 United States | Retrospective pre-post | Ambulatory care clinics in an ACO health care network | 1032 | 59.5 (11.9) | 47.4 | 12 | HbA1ce | Physician; BH specialist; care coordinator; pharmacist; registered nurse (mostly CDE) (5) | CPA; shared EMRs; weekly team meetings/rounds/huddles; colocation; face-to-face communication (DDMP)f,g,i,j |
| Gilstrap et al,54 2013 United States | Retrospective pre-post | Community health center | 64 | 51.3 | 0 | 24 | HbA1ce | Physician; cardiologist; dietitian; health coach; physical therapist (4) | Colocation (HAPPY Heart Program)f,g |
| SBPe | |||||||||
| DBPe | |||||||||
| Hassaballa et al,55 2015 United States | Retrospective pre-post | FQCHC | 148 | Not reported | 0 | 16 | HbA1ce | Physician; BH specialist; CDE; diabetes nurse case manager; diabetes health ambassador (CHW); dietitian; nurse high-risk case manager; outreach nurse; patient navigator; pharmacist specialist; program manager; quality assurance manager (10) | Joint or group educational sessions; PCMH model; shared medical appointments or group visits; colocation (DCCP)f,g,j |
| SBP | |||||||||
| DBPe | |||||||||
| Martin et al,56 2015 United States | Retrospective pre-post | Community health center | 48 | Not reported | Not reported | About 8.3, average of 250 d | HbA1ce | Nurse practitioner/physician; nurse; pharmacists; pharmacy students under the supervision of pharmacist preceptors; registered dietitian (4) | Colocation; face-to-face communication shared medical appointments (in a single visit, the patient met with the nurse, then the pharmacy students, then the dietitian, and in addition the physician or nurse practitioner; health care professionals met at the end of clinic day and discussed patients and set follow-up.) |
| Moinfar et al,57 2016 Iran | Retrospective pre-post | Ambulatory care centers (academic institution) | 435 | 56.5 (9.7) | 3 | 3 | HbA1ce | Physician; nurse; nutritionist; psychologist could be consulted (4) | Colocation; IP group educational sessions on diagnosis and management of psychiatric disorders; use of practice guidelines developed in consultation with specialist physicians in consensus panel sessionsf,i,j |
| SBPe | |||||||||
| DBPe | |||||||||
| FBG | |||||||||
| Nagelkerk et al,58 2018 United States | Retrospective pre-post | FQCHC | 250 | 57.3 (12.1) | 38.4 | 12 | HbA1ce | Physician; dietitian, medical assistant; medical students; nurse; pharmacy students; physician assistant students (5) | Daily huddles, collaborative care plans, team visits, patient phone call follow-up, medication reconciliations, and student-led group diabetic visit guidelines; colocation; face-to-face communication |
| Provost et al,59 2017 Canada | Retrospective pre-post | Health and social services center + collaboration with PCPs | 1689 | 58.5 | 43.1 | 12 | HbA1ce | Physician; kinesiologist; nurse; nutritionist; pharmacist; social worker (6) | Joint or group educational sessions; shared medical appointments or group visits; shared EMR; regularly scheduled meetings with interdisciplinary teams |
| SBPe | |||||||||
| DBPe | |||||||||
| Singh-Franco et al,60 2013 United States | Retrospective pre-post | Mobile clinic | 114 | 63 (11) | 15 | 12 | HbA1ce | Physician; nurse; nutritionist; pharmacist specialist in ambulatory care; translator (5) | Colocation; face-to-face communicationf,g,i,j |
| SBP | |||||||||
| Statin use | |||||||||
| Watts et al,61 2015 United States | Retrospective pre-post | Primary care clinic within Veterans Affairs | 1170 | 62.6 (9.1) | 96 | 6 | HbA1ce | Physician; CDE (either an NP or a clinical pharmacy specialist); general internist; health psychologist; registered dietitian (4) | Shared medical appointments or group visits; colocation; face-to-face communicationf,j |
| Zwar et al,62 2007 Australia | Retrospective pre-postn | Health maintenance organization ambulatory care clinics | 230 | 61.2 (11.4) | 50.4 | 12 | HbA1ce | Physician; diabetes educator; dietitian; optometrist; podiatrist (5) | Shared EMRsj |
| SBPe | |||||||||
| DBPe | |||||||||
Abbreviations: ACIC, assessment of chronic illness care; ACO, accountable care organization; ASCVD, atherosclerotic cardiovascular disease; BH, behavioral health; C, comparison; CDE, board certified diabetes educator; CHW, community health worker; CPA, collaborative practice agreement; CV, cardiovascular; DBP, diastolic blood pressure; DCCP, diabetes care coordination program; DDMP, diabetes disease management program; EMPOWER–PAR, engaging and motivating patients online with enhanced resources-participatory action research; EMR, electronic medical record; FBG, fasting blood glucose; FQCHC, federally qualified community health center; HAPPY, health awareness and primary prevention in your neighborhood; HbA1c, hemoglobin A1C; I, intervention; ICP, interprofessional collaborative practice; IP, interprofessional; MEDIC-E, multidisciplinary education and diabetes intervention for cardiac risk reduction–extended; NP, nurse practitioner; PACT, patient-aligned care team; PCMH, patient-centered medical home; PCP, primary care professional; RCT, randomized clinical trial; SBP, systolic blood pressure; VA-MEDIC, Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction.
a
Total number of enrolled patients; the number in analysis (Study N) are reported in forest plots (Figure 2, Figure 3, eMethod, and eFigure 1 in the Supplement).
b
First team member listed represents the primary care professional who served the gatekeeper functions of the “primary care provider.”
c
Data reported descriptively as each manuscript described/defined the interprofessional team/features/processes and based on the predetermined data extraction categories used in this meta-analysis.
d
Facility level.
e
An outcome that was included in the meta-analysis.
f
Patient education/counseling.
g
Health promotion/disease prevention.
h
Patient level.
i
Medication management.
j
Chronic disease management.
k
Adherence support.
l
Village level.
m
The study analyzed HbA1c change from baseline to 18 and 36 months; the 18-month data was used in the meta-analysis.
n
Pre-post study comparing 2 independent groups before and after the intervention (before-and-after study).