scholarly journals Alternative service models for delivery of healthcare services in high-income countries: a scoping review of systematic reviews

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e024385 ◽  
Author(s):  
Rebecca L Jessup ◽  
Denise A O’Connor ◽  
Polina Putrik ◽  
Kobi Rischin ◽  
Janet Nezon ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Systematic Reviews ◽  
Scoping Review ◽  
Healthcare Services ◽  
High Income ◽  
Primary Data ◽  
Delivery Of Healthcare ◽  
Service Models ◽  
Alternative Delivery

IntroductionCosts associated with the delivery of healthcare services are growing at an unsustainable rate. There is a need for health systems and healthcare providers to consider the economic impacts of the service models they deliver and to determine if alternative models may lead to improved efficiencies without compromising quality of care. The aim of this protocol is to describe a scoping review of the extent, range and nature of available synthesised research on alternative delivery arrangements for health systems relevant to high-income countries published in the last 5 years.DesignWe will perform a scoping review of systematic reviews of trials and economic studies of alternative delivery arrangements for health systems relevant to high-income countries published on ‘Pretty Darn Quick’ (PDQ)-Evidence between 1 January 2012 and 20 September 2017. All English language systematic reviews will be included. The Cochrane Effective Practice and Organisation of Care taxonomy of health system interventions will be used to categorise delivery arrangements according to: how and when care is delivered, where care is provided and changes to the healthcare environment, who provides care and how the healthcare workforce is managed, co-ordination of care and management of care processes and information and communication technology systems. This work is part of a 5-year Partnership Centre for Health System Sustainability aiming to investigate and create interventions to improve health-system-performance sustainability.Ethics and disseminationNo primary data will be collected, so ethical approval is not required. The study findings will be published and presented at relevant conferences.

scholarly journals Identifying alternative models of healthcare service delivery to inform health system improvement: scoping review of systematic reviews

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e036112 ◽  
Author(s):  
Rebecca Jessup ◽  
Polina Putrik ◽  
Rachelle Buchbinder ◽  
Janet Nezon ◽  
Kobi Rischin ◽  
...  
Keyword(s):  
Health System ◽  
Patient Outcomes ◽  
Systematic Reviews ◽  
Scoping Review ◽  
Resource Use ◽  
Healthcare Delivery ◽  
High Income ◽  
Economic Evaluations ◽  
Wide Range ◽  
System Improvement

ObjectiveTo describe available evidence from systematic reviews of alternative healthcare delivery arrangements relevant to high-income countries to inform decisions about healthcare system improvement.DesignScoping review of systematic reviews.Data sourcesSystematic reviews of interventions indexed in Pretty Darn Quick-Evidence.Eligibility criteriaAll English language systematic reviews evaluating the effects of alternative delivery arrangements relevant to high-income countries, published between 1 January 2012 and 20 September 2017. Eligible reviews had to summarise evidence on at least one of the following outcomes: patient outcomes, quality of care, access and/or use of healthcare services, resource use, impacts on equity and/or social outcomes, healthcare provider outcomes or adverse effects.Data extraction and synthesisJournal, publication year, number and design of primary studies, populations/health conditions represented and types of outcomes were extracted.ResultsOf 829 retrieved records, 531 reviews fulfilled our inclusion criteria. Almost all (93%) reviews reported on patient outcomes, while only about one-third included resource use as an outcome of interest. Just over a third (n=189, 36%) of reviews focused on alternative information and communications technology interventions (including 162 reviews on telehealth). About one-quarter (n=122, 23%) of reviews focused on alternative care coordination interventions. 15% (n=80) of reviews examined interventions involving changes to who provides care and how the healthcare workforce is managed. Few reviews investigated the effects of interventions involving changes to how and when care is delivered (n=47, 9%) or interventions addressing a goal-focused question (n=38, 7%).ConclusionA substantial body of evidence about the effects of a wide range of delivery arrangements is available to inform health system improvements. The lack of economic evaluations in the majority of systematic reviews of delivery arrangements means that the value of many of these models is unknown. This scoping review identifies evidence gaps that would be usefully addressed by future research.

scholarly journals Correlation of mesolevel characteristics of the healthcare system and socioeconomic inequality in healthcare use: a scoping review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044301
Author(s):  
Anna Novelli ◽  
Wiebke Schüttig ◽  
Jacob Spallek ◽  
Benjamin Wachtler ◽  
Katharina Diehl ◽  
...  
Keyword(s):  
Health Systems ◽  
Scoping Review ◽  
Selection Process ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Primary Data ◽  
Healthcare Use ◽  
Scoping Reviews ◽  
The Impact ◽  
Socioeconomic Inequity

IntroductionAlthough the impact of macrolevel characteristics of health systems on socioeconomic inequity in health has been studied extensively, the impact of access characteristics on a smaller scale of health systems has received less attention. These mesolevel characteristics can influence access to healthcare and might have the potential to moderate or aggravate socioeconomic inequity in healthcare use. This scoping review aims to map the existing evidence of the association of socioeconomic inequity in healthcare use and mesolevel access characteristics of the health system.Methods and analysisIn conducting the scoping review, we follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols Extension for Scoping Reviews. The search will be carried out in four scientific databases: MEDLINE (via PubMed), Web of Science, Scopus and PsycINFO. Main eligibility criteria are inclusion in the analysis of a measure of socioeconomic position, a measure of individual healthcare use and a mesolevel determinant of access to healthcare services. The selection process consists of two consecutive screening stages (first: title/abstract; second: full text). At both stages, two reviewers independently assess the eligibility of studies. In case of disagreement, a third reviewer will be involved. Cohen’s kappa will be calculated to report inter-rater agreement between reviewers. Results are synthesised narratively, as a high heterogeneity of studies is expected.Ethics and disseminationNo primary data are collected for the presented scoping review. Therefore, ethical approval is not necessary. The scoping review will be published in an international peer-reviewed journal, and findings will be presented on national and international conferences.

scholarly journals Strategies for reducing out of pocket payments in the health system: a scoping review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Faride Sadat Jalali ◽  
Parisa Bikineh ◽  
Sajad Delavari
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Health Financing ◽  
Developed Countries ◽  
Vulnerable Groups ◽  
System A ◽  
Out Of Pocket Payments ◽  
Review Study ◽  
Developing And Developed Countries

Abstract Background Direct out-of-pocket payments (OOP) are among the most important financing mechanisms in many health systems, especially in developing countries, adversely affecting equality and leading vulnerable groups to poverty. Therefore, this scoping review study was conducted to identify the strategies involving OOP reduction in health systems. Methods Articles published in English on strategies related to out-of-pocket payments were Searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between January 2000 and November 2020, following PRISMA guidelines. As a result, 3710 papers were retrieved initially, and 40 were selected for full-text assessment. Results Out of 40 papers included, 22 (55%) and 18 (45%) of the study were conducted in developing and developed countries, respectively. The strategies were divided into four categories based on health system functions: health system stewardship, creating resources, health financing mechanisms, and delivering health services.As well, developing and developed countries applied different types of strategies to reduce OOP. Conclusion The present review identified some strategies that affect the OOP payments According to the health system functions framework. Considering the importance of stewardship, creating resources, the health financing mechanisms, and delivering health services in reducing OOP, this study could help policymakers make better decisions for reducing OOP expenditures.

scholarly journals What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jennifer B. Nuzzo ◽  
Diane Meyer ◽  
Michael Snyder ◽  
Sanjana J. Ravi ◽  
Ana Lapascu ◽  
...  
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Health System ◽  
Natural Hazards ◽  
Health Systems ◽  
Scoping Review ◽  
Disease Outbreaks ◽  
World Health ◽  
Infectious Disease Outbreaks ◽  
System Resilience

Abstract Background The 2014–2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency. Methods We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization’s Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations. Results We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings. Conclusions An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.

scholarly journals Built to last? The sustainability of health system improvements, interventions and change strategies: a study protocol for a systematic review

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018568 ◽  
Author(s):  
Jeffrey Braithwaite ◽  
Luke Testa ◽  
Gina Lamprell ◽  
Jessica Herkes ◽  
Kristiana Ludlow ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Health Systems ◽  
Full Text ◽  
English Language ◽  
Secondary Data ◽  
Primary Data ◽  
Change Strategies ◽  
Screening Process ◽  
Sustainable Health

IntroductionThe sustainability of healthcare interventions and change programmes is of increasing importance to researchers and healthcare stakeholders interested in creating sustainable health systems to cope with mounting stressors. The aim of this protocol is to extend earlier work and describe a systematic review to identify, synthesise and draw meaning from studies published within the last 5 years that measure the sustainability of interventions, improvement efforts and change strategies in the health system.Methods and analysisThe protocol outlines a method by which to execute a rigorous systematic review. The design includes applying primary and secondary data collection techniques, consisting of a comprehensive database search complemented by contact with experts, and searching secondary databases and reference lists, using snowballing techniques. The review and analysis process will occur via an abstract review followed by a full-text screening process. The inclusion criteria include English-language, peer-reviewed, primary, empirical research articles published after 2011 in scholarly journals, for which the full text is available. No restrictions on location will be applied. The review that results from this protocol will synthesise and compare characteristics of the included studies. Ultimately, it is intended that this will help make it easier to identify and design sustainable interventions, improvement efforts and change strategies.Ethics and disseminationAs no primary data were collected, ethical approval was not required. Results will be disseminated in conference presentations, peer-reviewed publications and among policymaker bodies interested in creating sustainable health systems.

scholarly journals Use of the Safewards Model in healthcare services: a mixed-method scoping review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e039109
Author(s):  
Marie Gerdtz ◽  
Catherine Daniel ◽  
Rebecca Jarden ◽  
Suzanne Kapp
Keyword(s):  
Systematic Reviews ◽  
Scoping Review ◽  
Mixed Method ◽  
Meta Analysis ◽  
Healthcare Services ◽  
Future Research ◽  
Mixed Method Research ◽  
Scoping Reviews ◽  
Ethical Approval ◽  
Safety Considerations

IntroductionSafewards is an organisational approach to delivering inpatient mental health services. The aim of Safewards is to minimise the number of situations in which conflict arises between healthcare workers and patients that lead to the use of coercive interventions (restriction and/or containment).The Safewards Model has been developed, implemented and evaluated for its impact on all forms of containment. Safewards has been adopted as the recommended approach to preventing patient agitation and clinical aggression in some jurisdictions. Notwithstanding these recommendations, the outcomes of Safewards for staff and patients have not been comprehensively described.The aim of the scoping review is to describe (1) Safewards interventions; (2) how Safewards interventions have been implemented in healthcare settings; (3) outcome measures used to evaluate the effectiveness of Safewards; (4) barriers and enablers to the uptake and sustainability of Safewards. This review will provide a foundation for further research and/or systematic review of the effectiveness of Safewards.Methods and analysisPeer-reviewed manuscripts of quantitative, qualitative and mixed-method research in English with be included for the period 01 January 2013– December 31st 2020. Electronic databases including Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase, Emcare, Joanna Briggs Institute, Medline, Global Health, PsycINFO and Scopus will be searched. Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist and explanation and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol will be followed. Publications will be excluded if they do not include the required participants, concept or context. Two reviewers will independently screen all titles and abstracts and full-text studies for inclusion.Ethics and disseminationEthical approval for this review is not required as the information to be collected is publicly available. There are no participants or safety considerations in this review of published literature. Key findings for future research and clinical practice will be disseminated though peer-reviewed publication, stakeholder reporting and conference presentations.

scholarly journals Health System Resilience: What Are We Talking About? A Scoping Review Mapping Characteristics and Keywords

2019 ◽  
Vol 9 (1) ◽  
pp. 6-16 ◽  
Author(s):  
My Fridell ◽  
Sanna Edwin ◽  
Johan von Schreeb ◽  
Dell D. Saulnier
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
World Health ◽  
Systems Research ◽  
Quality Health ◽  
System Resilience ◽  
Health Organization ◽  
Key Terms

Background: Health systems are based on 6 functions that need to work together at all times to effectively deliver safe and quality health services. These functions are vulnerable to shocks and changes; if a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. The concept of resilience has been introduced with the goal of strengthening health systems to avoid disruption or collapse. The concept is new within health systems research, and no common description exists to describe its meaning. The aim of this study is to summarize and characterize the existing descriptions of health system resilience to improve understanding of the concept. Methods and Analysis: A scoping review was undertaken to identify the descriptions and characteristics of health system resilience. Four databases and gray literature were searched using the keywords "health system" and "resilience" for published documents that included descriptions, frameworks or characteristics of health system resilience. Additional documents were identified from reference lists. Four expert consultations were conducted to gain a broader perspective. Descriptions were analysed by studying the frequency of key terms and were characterized by using the World Health Organization (WHO) health system framework. The scoping review identified eleven sources with descriptions and 24 sources that presented characteristics of health system resilience. Frequently used terms that were identified in the literature were shock, adapt, maintain, absorb and respond. Change and learning were also identified when combining the findings from the descriptions, characteristics and expert consultations. Leadership and governance were recognized as the most important building block for creating health system resilience. Discussion: No single description of health system resilience was used consistently. A variation was observed on how resilience is described and to what depth it was explained in the existing literature. The descriptions of health system resilience primarily focus on major shocks. Adjustments to long-term changes and the element of learning should be considered for a better understating of health system resilience.

scholarly journals Innovation, Demand, and Responsibility: Some Fundamental Questions About Health Systems Comment on "What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review"

2019 ◽  
Vol 8 (9) ◽  
pp. 567-569 ◽  
Author(s):  
Harro van Lente
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
Responsible Innovation

In this commentary on the exercise of Lehoux et al (this volume) I argue that in discussions on the current challenges of health systems, a better diagnosis of the health system is required. The cause of responsible innovation in health (RIH) requires a better understanding of the dynamics of health systems, in particular how innovation, demand, and responsibility are manifested. Innovation brings its own dynamic to the health system; demands are linked to historical and social developments; responsibility brings contestations about what counts as good healthcare. Any attempt of RIH should include such reflections.

scholarly journals Antenatal care policy in high-income countries with a universal health system: a scoping review

2021 ◽  
Author(s):  
Andreia Soares Goncalves ◽  
Isabel Maria Ferreira ◽  
Márcia Pestana-Santos ◽  
Christine McCourt ◽  
Ana Paula Prata
Keyword(s):  
Antenatal Care ◽  
Health System ◽  
Scoping Review ◽  
Grey Literature ◽  
Perinatal Outcomes ◽  
High Income ◽  
The United Kingdom ◽  
Effective Care ◽  
Care Policies ◽  
Universal Health

AbstractThe availability, effectiveness, and access to antenatal care are directly linked with good maternal and neonatal outcomes, making antenatal care an important determinant in health. But to be effective, care must always be appropriate, not excessive, not insufficient. Perinatal outcomes vary within and between countries, raising questions about practices, the use of best evidence in clinical decisions and the existence of clear and updated guidance.Through a scoping review methodology, this study aimed to map the available antenatal care policies for low-risk pregnant women in high-income countries with a universal health system founded on the Beveridge Model.Following searches on the main databases and grey literature, the authors identified and analysed ten antenatal care policies: Australia, Denmark, Finland, Iceland, Italy, Norway, Portugal, Spain, Sweden and the United Kingdom. Some policies were over 10 years old, some recommendations did not present a rationale or context, others were outdated, or were simply different approaches in the absence of strong evidence. Whilst some recommendations were ubiquitous, others differed either in the recommendation provided, the timing, or the frequency. Similarly, we found wide variation in the methods/strategy used to support the recommendations provided. These results confirms that best evidence is not always assimilated into policies and clinical guidance. Further research crossing these differences with perinatal outcomes and evaluation of cost could be valuable to optimise guidance on antenatal care. Similarly, some aspects of care need further rigorous studies to obtain evidence of higher quality to inform recommendations.

PP22 How Do Health System Leaders Use Evidence To Inform Action?

2018 ◽  
Vol 34 (S1) ◽  
pp. 74-75
Author(s):  
Matthew D Mitchell ◽  
C Michael White ◽  
Jeanne-Marie Guise ◽  
Lionel Bañez ◽  
Craig Umscheid ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Process Improvement ◽  
Systematic Reviews ◽  
Predictive Analytics ◽  
Structured Interview ◽  
Healthcare Research ◽  
System Quality ◽  
Study Results ◽  
System Leaders

Introduction:The US Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) program sponsors the development of systematic reviews to inform clinical policy and practice. The EPC program sought to better understand how health systems identify and use this evidence.Methods:Representatives from eleven EPCs, the EPC Scientific Resource Center, and AHRQ developed a semi-structured interview script to query a diverse group of nine Key Informants (KIs) involved in health system quality, safety and process improvement about how they identify and use evidence. Interviews were transcribed and qualitatively summarized into key themes.Results:All KIs reported that their organizations have either centralized quality, safety, and process improvement functions within their system, or they have partnerships with other organizations to conduct this work. There was variation in how evidence was identified, with larger health systems having medical librarians and central bureaus to gather and disseminate information and smaller systems having local chief medical officers or individual clinicians do this work. KIs generally prefer guidelines, especially those with treatment algorithms, because they are actionable. They like systematic reviews because they efficiently condense study results and reconcile conflicting data. They prefer information from systematic reviews to be presented as short digestible summaries with the full report available on demand. KIs preferred systematic reviews from reputable entities and those without commercial bias. Some of the challenges KIs reported include how to resolve conflicting evidence, the generalizability of evidence to local needs, determining whether the evidence is up-to-date, and the length of time required to generate reviews. The topics of greatest interest included predictive analytics, high-value care, advance care planning, and care coordination. To increase awareness of AHRQ EPC reviews, KIs suggest alerting people at multiple levels in a health-system when new evidence reports are available and making reports easier to find in common search engines.Conclusions:Systematic reviews are valued by health system leaders. To be most useful they should be easy to locate and available in different formats targeted to the needs of different audiences.

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