Effects of oncological care pathways in primary and secondary care on patient, professional, and health systems outcomes: protocol for a systematic review and meta-analysis

Abstract Background Pathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify, and synthesise existing literature on the effects of pathways in oncological care. Methods All patients diagnosed with cancer in primary and secondary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding “patient outcomes” and “costs” were extracted from each study. Results Out of 12,689 search results, we selected 158 articles eligible for full text assessment. The remaining 10 studies represented 4,786 patients. Most studies were conducted in secondary care. LOS was the most common used indicator for patients outcomes, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter LOS regarding gastric cancer (WMD: -2.75, CI: -4.67–-0.83) and gynaecological cancer (WMD: -1.58, CI: -2.10–-1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups. Conclusions Despite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary care regarding the positive effects of LOS in favour of cancer care pathways.

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Effects of oncological care pathways in primary and secondary care on patient, professional and health systems outcomes: a systematic review and meta-analysis

10.21203/rs.2.22759/v3 ◽

2020 ◽

Author(s):

Jolanda C. van Hoeve ◽

Robin W.M. Vernooij ◽

Michelle Fiander ◽

Peter Nieboer ◽

Sabine Siesling ◽

...

Keyword(s):

Systematic Review ◽

Cancer Care ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Tertiary Care ◽

Evidence Base ◽

System Level ◽

Care Pathways ◽

Positive Effects ◽

Oncological Care

Abstract Background: Pathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify, and synthesise existing literature on the effects of pathways in oncological care. Methods: All patients diagnosed with cancer in primary and secondary/tertiary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding patients, professionals and system level were extracted from each study. Results: Out of 13,847 search results, we selected 158 articles eligible for full text assessment. 150 studies were excluded and the remaining eight studies represented 4,786 patients. Most studies were conducted in secondary/tertiary care. Length of Stay (LOS) was the most common used indicator, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter LOS regarding gastric cancer (Weighted Mean Difference (WMD)): -2.75, CI: -4.67–-0.83) and gynaecological cancer (WMD: -1.58, CI: -2.10–-1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups. Conclusions: Despite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary/tertiary care regarding the positive effects of LOS in favour of cancer care pathways. Systematic review registration: PROSPERO CRD42017057592

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Effects of oncological care pathways in primary and secondary care on patient, professional and health systems outcomes: a systematic review and meta-analysis

Systematic Reviews ◽

10.1186/s13643-020-01498-0 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Jolanda C. van Hoeve ◽

Robin W. M. Vernooij ◽

Michelle Fiander ◽

Peter Nieboer ◽

Sabine Siesling ◽

...

Keyword(s):

Systematic Review ◽

Cancer Care ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Gynecological Cancer ◽

Tertiary Care ◽

System Level ◽

Care Pathways ◽

Positive Effects ◽

Oncological Care

Abstract Background Pathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify and synthesize existing literature on the effects of pathways in oncological care. Methods All patients diagnosed with cancer in primary and secondary/tertiary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding patients, professionals, and system level were extracted from each study. Results Out of 13,847 search results, we selected 158 articles eligible for full text assessment. One hundred fifty studies were excluded and the remaining eight studies represented 4786 patients. Most studies were conducted in secondary/tertiary care. Length of stay (LOS) was the most common used indicator, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter LOS regarding gastric cancer (weighted mean difference (WMD)): − 2.75, CI: − 4.67 to − 0.83) and gynecological cancer (WMD: − 1.58, CI: − 2.10 to − 1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups. Conclusions Despite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary/tertiary care regarding the positive effects of LOS in favor of cancer care pathways. Systematic review registration PROSPERO CRD42017057592.

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Effects of oncological care pathways in primary and secondary care on patient, professional and health systems outcomes: a systematic review and meta-analysis

10.21203/rs.2.22759/v2 ◽

2020 ◽

Author(s):

Jolanda C. van Hoeve ◽

Robin W.M. Vernooij ◽

Michelle Fiander ◽

Peter Nieboer ◽

Sabine Siesling ◽

...

Keyword(s):

Systematic Review ◽

Cancer Care ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Tertiary Care ◽

Evidence Base ◽

System Level ◽

Care Pathways ◽

Positive Effects ◽

Oncological Care

Abstract Background: Pathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify, and synthesise existing literature on the effects of pathways in oncological care. Methods: All patients diagnosed with cancer in primary and secondary/tertiary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding patients, professionals and system level were extracted from each study. Results: Out of 13,847 search results, we selected 158 articles eligible for full text assessment. 150 studies were excluded and the remaining eight studies represented 4,786 patients. Most studies were conducted in secondary/tertiary care. LOS was the most common used indicator, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter Length of Stay (LOS) regarding gastric cancer (Weighted Mean Difference (WMD)): -2.75, CI: -4.67–-0.83) and gynaecological cancer (WMD: -1.58, CI: -2.10–-1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups. Conclusions: Despite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary/tertiary care regarding the positive effects of LOS in favour of cancer care pathways. Systematic review registration: PROSPERO CRD42017057592

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Faecal calprotectin to detect inflammatory bowel disease: a systematic review and exploratory meta-analysis of test accuracy

BMJ Open ◽

10.1136/bmjopen-2018-027428 ◽

2019 ◽

Vol 9 (3) ◽

pp. e027428 ◽

Cited By ~ 7

Author(s):

Karoline Freeman ◽

Brian H Willis ◽

Hannah Fraser ◽

Sian Taylor-Phillips ◽

Aileen Clarke

Keyword(s):

Systematic Review ◽

Primary Care ◽

Inflammatory Bowel Disease ◽

Sensitivity And Specificity ◽

Bowel Disease ◽

Secondary Care ◽

Meta Analysis ◽

Test Accuracy ◽

Faecal Calprotectin ◽

Inflammatory Bowel

ObjectiveTest accuracy of faecal calprotectin (FC) testing in primary care is inconclusive. We aimed to assess the test accuracy of FC testing in primary care and compare it to secondary care estimates for the detection of inflammatory bowel disease (IBD).MethodsSystematic review and meta-analysis of test accuracy using a bivariate random effects model. We searched MEDLINE, EMBASE, Cochrane Library and Web of Science until 31 May 2017 and included studies from auto alerts up until 31 January 2018. Eligible studies measured FC levels in stool samples to detect IBD in adult patients with chronic (at least 6–8 weeks) abdominal symptoms in primary or secondary care. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. We followed the protocol registered as PROSPERO CRD 42012003287.Results38 out of 2168 studies were eligible including five from primary care. Comparison of test accuracy by setting was precluded by extensive heterogeneity. Overall, summary estimates of sensitivity and specificity were not recorded. At a threshold of 50 µg/g, sensitivity from separate meta-analysis of four assay types ranged from 0.85 (95% CI 0.75 to 0.92) to 0.94 (95% CI 0.75 to 0.90) and specificity from 0.67 (95% CI 0.56 to 0.76) to 0.88 (95% CI 0.77 to 0.94). Across three different definitions of disease, sensitivity ranged from 0.80 (95% CI 0.76 to 0.84) to 0.97 (95% CI 0.91 to 0.99) and specificity from 0.67 (95% CI 0.58 to 0.75) to 0.76 (95% CI 0.66 to 0.84). Sensitivity appears to be lower in primary care and is further reduced at a revised threshold of 100 µg/g.ConclusionsConclusive estimates of sensitivity and specificity of FC testing in primary care for the detection of IBD are still missing. There is insufficient evidence in the published literature to support the decision to introduce FC testing in primary care. Studies evaluating FC testing in an appropriate primary care setting are needed.

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Musculoskeletal care pathways for adults with hip and knee pain at the interface between primary and secondary care: protocol for a systematic review

Systematic Reviews ◽

10.1186/s13643-016-0301-x ◽

2016 ◽

Vol 5 (1) ◽

Cited By ~ 2

Author(s):

Kate Button ◽

Fiona Morgan ◽

Helen Hodgson ◽

Alison L. Weightman ◽

Steve Jones

Keyword(s):

Systematic Review ◽

Knee Pain ◽

Secondary Care ◽

Care Pathways ◽

Care Protocol ◽

Musculoskeletal Care

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Remote home monitoring (virtual wards) during the COVID-19 pandemic: a living systematic review

10.1101/2020.10.07.20208587 ◽

2020 ◽

Cited By ~ 1

Author(s):

Cecilia Vindrola-Padros ◽

Kelly E Singh ◽

Manbinder S Sidhu ◽

Theo Georghiou ◽

Chris Sherlaw-Johnson ◽

...

Keyword(s):

Systematic Review ◽

Patient Safety ◽

Outcome Measures ◽

Secondary Care ◽

Meta Analysis ◽

Eligible Patient ◽

Home Monitoring ◽

Healthcare Sector ◽

Future Research ◽

The Impact

ABSTRACTObjectivesThe aim of this review was to analyse the implementation and impact of remote home monitoring models (virtual wards) during COVID-19, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt. The review will be kept ‘live’ through regular updates.DesignThe review was designed as a living systematic review to capture a rapidly evolving evidence base. We used the Preferred Reporting Items for Systematic Reviews and Meta- Analysis (PRISMA) statement.SettingThe review included remote home monitoring models led by primary and secondary care across seven countries.Participants17 examples of remote home monitoring models were included in the review.Main outcome measuresImpact of remote home monitoring on virtual length of stay, escalation, Emergency department attendance/reattendance, admission/readmission and mortality.ResultsThe primary aim of the remote home monitoring models was the early identification of deterioration for patients self-managing COVID-19 symptoms at home. Most models were led by secondary care. Broad criteria for the eligible patient population were used and confirmation of COVID-19 was not required (in most cases). Monitoring was carried via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. We could not reach conclusions regarding patient safety and the identification of early deterioration due to lack of standardised reporting across articles and missing data. None of the articles reported any form of economic analysis, beyond how the resources were used.ConclusionsThe review pointed to variability in the implementation of the models, in relation to healthcare sector, monitoring approach and selected outcome measures. Lack of standardisation on reporting prevented conclusions on the impact of remote home monitoring on patient safety or early escalation during COVID-19. Future research should focus on staff and patient experiences of care and potential inequalities in patients’ access to these models. Attention needs to be paid to the processes used to implement these models, the evaluation of their impact on patient outcomes through the use of comparators, the use of risk-stratification tools, and cost-effectiveness of the models and their sustainability.Protocol registrationThe review protocol was published on PROSPERO (CRD: 42020202888).

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Health service organisation impact on lower extremity amputations in people with type 2 diabetes with foot ulcers: systematic review and meta-analysis

Acta Diabetologica ◽

10.1007/s00592-020-01662-x ◽

2021 ◽

Author(s):

Bernardo Meza-Torres ◽

Fabrizio Carinci ◽

Christian Heiss ◽

Mark Joy ◽

Simon de Lusignan

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Lower Extremity ◽

Meta Analysis ◽

Lower Extremity Amputation ◽

Foot Ulcers ◽

Multidisciplinary Teams ◽

Care Pathways ◽

Extremity Amputation

Abstract Aims Despite the evidence available on the epidemiology of diabetic foot ulcers and associated complications, it is not clear how specific organizational aspects of health care systems can positively affect their clinical trajectory. We aim to evaluate the impact of organizational aspects of care on lower extremity amputation rates among people with type 2 diabetes affected by foot ulcers. Methods We conducted a systematic review of the scientific literature published between 1999 and 2019, using the following key terms as search criteria: people with type 2 diabetes, diagnosed with diabetic foot ulcer, treated with specific processes and care pathways, and LEA as primary outcome. Overall results were reported as pooled odds ratios and 95% confidence intervals obtained using fixed and random effects models. Results A total of 57 studies were found eligible, highlighting the following arrangements: dedicated teams, care pathways and protocols, multidisciplinary teams, and combined interventions. Among them, seven studies qualified for a meta-analysis. According to the random effects model, interventions including any of the four arrangements were associated with a 29% reduced risk of any type of lower extremity amputation (OR = 0.71; 95% CI 0.52–0.96). The effect was larger when focusing on major LEAs alone, leading to a 48% risk reduction (OR = 0.52; 95% CI 0.30–0.91). Conclusions Specific organizational arrangements including multidisciplinary teams and care pathways can prevent half of the amputations in people with diabetes and foot ulcers. Further studies using standardized criteria are needed to investigate the cost-effectiveness to facilitate wider implementation of improved organizational arrangements. Similarly, research should identify specific roadblocks to translating evidence into action. These may be structures and processes at the health system level, e.g. availability of professionals with the right skillset, reimbursement mechanisms, and clear organizational intervention implementation guidelines.

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