scholarly journals Measuring Health Equity in Emergency Care Using Routinely Collected Data: A Systematic Review

2021 ◽  
Author(s):  
Kevin Morisod ◽  
Xhyljeta Luta ◽  
Joachim Marti ◽  
Jacques Spycher ◽  
Mary Malebranche ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Administrative Data ◽  
Emergency Care ◽  
Social Deprivation ◽  
Care Pathway ◽  
Health Care Systems ◽  
Insurance Coverage ◽  
Health Care Equity ◽  
Ed Visits

Identifying health care equity indicators is an important first step in integrating the concept of equity into assessments of health care system performance, particularly in emergency care. We conducted a systematic review of administrative data-derived health care equity indicators and their association with socio-economic determinants of health (SEDH) in emergency care settings. Following PRISMA-Equity reporting guidelines, Ovid MEDLINE, EMBASE, PUBMED and Web of Science were searched for relevant studies. The outcomes of interest were indicators of health care equity and the associated SEDH they examine. Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care sensitive condition-related ED visits were the two most frequently used equity indicators. Despite some conflicting results, all identified SEDH (social deprivation, income, education level, social class, insurance coverage and health literacy) are associated with inequalities in access to and use of emergency care. In conclusion, the use of administrative data-derived indicators combined with identified SEDH could improve healthcare equity measurement in emergency care settings across health care systems worldwide.

scholarly journals Measuring health equity in emergency care using routinely collected data: a systematic review

2020 ◽  
Author(s):  
Kevin Morisod ◽  
Xhyljeta Luta ◽  
Joachim Marti ◽  
Jacques Spycher ◽  
Mary Malebranche ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Care System ◽  
Administrative Data ◽  
Emergency Care ◽  
Health Care Systems ◽  
Health Care Equity ◽  
Care Systems ◽  
Ed Visits ◽  
Care System

Abstract Abstract Background : Achieving equity in health care remains a challenge for health care systems worldwide and marked inequities in access and quality of care persist. The performance assessment of health care systems is often limited to quality and efficiency indicators. Identifying indicators of health care equity is an important first step in integrating the concept of equity into assessments of health care system performance. Because emergency care serves as the interface between ambulatory and inpatient care, it is arguably an opportune setting in which to begin this process. Methods: We conducted a systematic review of administrative data-derived health care equity indicators and their association with socio-economic determinants of health (SEDH) in emergency care settings. Following PRISMA-Equity reporting guidelines, Ovid MEDLINE, EMBASE, PUBMED and Web of Science were searched for relevant studies. The outcomes of interest were indicators of health care equity and the associated SEDH they examine. Results: Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care sensitive condition-related ED visits were the two most frequently used equity indicators. The studies analysed equity based on seven SEDH: social deprivation, income, education level, social class, insurance coverage, health literacy and financial and non-financial barriers. Despite some conflicting results, all identified SEDH are associated with inequalities in access to and use of emergency care. Conclusion: The use of administrative data-derived indicators in combination with identified SEDH could improve the measurement of health care equity in emergency care settings across health care systems worldwide. Using a combination of indicators is likely to lead to a more comprehensive, well-rounded measurement of health care equity than using any one indicator in isolation. Though studies analysed focused on emergency care settings, it seems possible to extrapolate these indicators to measure equity in other areas of the health care system. Further studies elucidating root causes of health inequities in and outside the health care system are needed. .

scholarly journals Assessing Health Care Equity Through Administrative Data-Derived Qquity Indicators and Socio-Economic Determinants of Health in Emergency Care: A Systematic Review

2020 ◽  
Author(s):  
Kevin Morisod ◽  
Xhyljeta Luta ◽  
Joachim Marti ◽  
Jacques Spycher ◽  
Mary Malebranche ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Administrative Data ◽  
Emergency Care ◽  
Health Care Systems ◽  
Economic Determinants ◽  
Health Care Equity ◽  
Care Systems ◽  
Ed Visits ◽  
Care System

Abstract Background: Achieving equity in health care remains a challenge for health care systems worldwide and marked inequities in access and quality of care persist. The performance assessment of health care systems is often limited to quality and efficiency indicators. Identifying indicators of health care equity is an important first step in integrating the concept of equity into assessments of health care system performance. Because emergency care serves as the interface between ambulatory and inpatient care, it appears to be a key setting in which to begin this process.Methods: We conducted a systematic review of administrative data-derived health care equity indicators and their association with socio-economic determinants of health (SEDH) in emergency care settings. Ovid MEDLINE, EMBASE, PUBMED and Web of Science were searched for relevant studies using administrative data following PRISMA-equity guidelines. The outcomes of interest were indicators of health care equity and the associated SEDH they examine.Results: Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care sensitive condition-related ED visits were the two most frequently used indicators. The studies analysed equity based on seven SEDH: social deprivation, income, education level, social class, insurance coverage, health literacy and financial and non-financial barriers. Despite some conflicting results, all identified SEDH are associated with inequalities in access to and use of emergency care. Conclusion: The use of administrative data-derived indicators in combination with identified SEDH could improve the measurement of health care equity in emergency care settings across health care systems worldwide. Using a combination of indicators is likely to lead to a more comprehensive, well-rounded analysis of health care equity than using any one indicator in isolation. Though studies analysed focused on emergency care settings, it seems possible to extrapolate these indicators to measure equity in other areas of the health care system. Further studies elucidating root causes of health inequities in and outside the health care system are needed.

scholarly journals Interventions to Reduce Adult Nursing Turnover: A Systematic Review of Systematic Reviews

2017 ◽  
Vol 11 (1) ◽  
pp. 108-123 ◽  
Author(s):  
Mary Halter ◽  
Ferruccio Pelone ◽  
Olga Boiko ◽  
Carole Beighton ◽  
Ruth Harris ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Systematic Reviews ◽  
Health Care Services ◽  
Health Care Systems ◽  
Large Body ◽  
Review Literature ◽  
Adult Health ◽  
Turnover Rates ◽  
Care Systems

Background: Nurse turnover is an issue of concern in health care systems internationally. Understanding which interventions are effective to reduce turnover rates is important to managers and health care organisations. Despite a plethora of reviews of such interventions, strength of evidence is hard to determine. Objective: We aimed to review literature on interventions to reduce turnover in nurses working in the adult health care services in developed economies. Method: We conducted an overview (systematic review of systematic reviews) using the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, Applied Social Sciences Index and Abstracts, CINAHL plus and SCOPUS and forward searching. We included reviews published between 1990 and January 2015 in English. We carried out parallel blinded selection, extraction of data and assessment of bias, using the Assessment of Multiple Systematic Reviews. We carried out a narrative synthesis. Results: Despite the large body of published reviews, only seven reviews met the inclusion criteria. These provide moderate quality review evidence, albeit from poorly controlled primary studies. They provide evidence of effect of a small number of interventions which decrease turnover or increase retention of nurses, these being preceptorship of new graduates and leadership for group cohesion. Conclusion: We highlight that a large body of reviews does not equate with a large body of high quality evidence. Agreement as to the measures and terminology to be used together with well-designed, funded primary research to provide robust evidence for nurse and human resource managers to base their nurse retention strategies on is urgently required.

Impact of Estimated GFR Reporting on Patients, Clinicians, and Health-Care Systems: A Systematic Review

2011 ◽  
Vol 57 (4) ◽  
pp. 592-601 ◽  
Author(s):  
Yoan K. Kagoma ◽  
Matthew A. Weir ◽  
Arthur V. Iansavichus ◽  
Brenda R. Hemmelgarn ◽  
Ayub Akbari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Care Systems ◽  
Estimated Gfr ◽  
Care Systems

scholarly journals A Systematic Review Opportunities and Challenges of Tele-cardiology in Health Care Systems

2020 ◽  
Vol 6 (4) ◽  
pp. 31-41
Author(s):  
Elham Maserat ◽  
Somayeh Davoodi ◽  
Zeinab Mohammadzadeh ◽  
Parina Amir Nahavandi ◽  
Navisa Abbasi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Care Systems ◽  
Care Systems

scholarly journals Patient-centered care pathways: what does it mean? An integrative conceptual framework to meet the need of an international consensus: a qualitative systematic review protocol

2021 ◽  
Author(s):  
Jean-Baptiste Gartner ◽  
Kassim Said Abasse ◽  
Ghita Ben Zagguou ◽  
Frédéric Bergeron ◽  
Paolo Landa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Care Delivery ◽  
Care Pathway ◽  
Patient Centered Care ◽  
Patient Centered ◽  
International Consensus ◽  
Patient Journey ◽  
Centered Care ◽  
Health Care Delivery Systems

Background: Faced with increased expectations regarding the quality and safety of health care delivery systems, a number of stakeholders are increasingly looking for more qualitative and efficient ways to deliver care. This study is conducted to provide a clear definition of the patient-centered care pathway and its characteristics to meet the need for an international consensus. Methods: This qualitative systematic review aims to perform a systematic synthesis of published evidence concerning (1) the definition of the patient trajectory, patient pathway or patient journey and (2) their characteristics. With a consulting librarian, a comprehensive and systematic search in three databases was conducted (PUBMED, Embase, ABI/Inform), from 1995 to 2020 without language criteria. Eligibility criteria guiding data selection will follow the PICo mnemonic criteria consisting of (1) Population : all types of patients managed by health care delivery systems for an acute or chronic condition regardless of age or condition, (2) Phenomena : studies that contribute to the definition and conceptualization of the concepts of care trajectory, care pathway and patient journey resulting in a theoretical and conceptual contribution, and (3) Context : health care providers include all providers of primary, secondary, tertiary, and quaternary care in any geographic area. Two reviewers will independently screen, select, extract data and make a critical assessment of the methodology used with the JBI Qualitative Assessment and Review Instrument (JBI QARI).Discussion: This systematic review will provide much-needed knowledge regarding patient-centered pathways. The results will benefit clinicians, decision makers, and researchers by giving them a clear and integrated definition and understanding of the patient-centered care pathways and their characteristics to finally meet the need for an international consensus.

scholarly journals Rotavirus disease and health care utilisation among children under 5 years of age in highly developed countries: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Cristina Ardura-Garcia ◽  
Christian Kreis ◽  
Milenko Rakic ◽  
Manon Jaboyedoff ◽  
Maria Christina Mallet ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Care ◽  
Nosocomial Infections ◽  
Meta Analysis ◽  
Developed Countries ◽  
Incidence Rates ◽  
Health Care Use ◽  
Ed Visits ◽  
Children Under 5

AbstractBackgroundRotavirus (RV) infection is the leading cause of diarrhoea-associated morbidity and mortality globally among children under 5 years of age. RV vaccination is available, but has not been implemented in many national immunisation plans, especially in highly developed countries. This systematic review aimed to estimate the prevalence and incidence of health care use for RV gastroenteritis (RVGE) among children aged under 5 years in highly developed countries without routine RV vaccination.MethodsWe searched MEDLINE and Embase databases from January 1st 2000 to December 17th 2018 for publications reporting on incidence or prevalence of RVGE-related health care use in children below 5 years of age: primary care and emergency department (ED) visits, hospitalisations, nosocomial infections and deaths. We included only studies with laboratory-confirmed RV infection, undertaken in highly developed countries with no RV routine vaccination plans. We used random effects meta-analysis to generate summary estimates with 95% confidence intervals (CI) and prediction intervals.ResultsWe screened 4033 abstracts and included 74 studies from 21 countries. Average incidence rates of RVGE per 100 000 person-years were: 2484 (95% CI 697-5366) primary care visits, 1890 (1597-2207) ED visits, 500 (422-584) hospitalisations, 34 (20-51) nosocomial infections and 0.04 (0.02-0.07) deaths. Average proportions of cases of acute gastroenteritis caused by RV were: 21% (95% CI 16-26%) for primary care visits; 32% (25-38%) for ED visits; 41% (36-47%) for hospitalisations, 29% (25-34%) for nosocomial infections and 12% (8-18%) for deaths. Results varied widely between and within countries, and heterogeneity was high (I2>90%) in most models.ConclusionRV in children under 5 years causes many healthcare visits and hospitalisations, with low mortality, in highly developed countries without routine RV vaccination. The health care use estimates for RVGE obtained by this study can be used to model RV vaccine cost-effectiveness in highly developed countries.Take home messageRV-caused illness leads to a high burden of health care usage in highly developed countries who have not introduced RV vaccination.

scholarly journals On the Front (Phone) Lines: Results of a COVID-19 Hotline in Northeast Ohio

2020 ◽  
Author(s):  
David Margolius ◽  
Mary Hennekes ◽  
Jimmy Yaho ◽  
Douglas Einstadter ◽  
Douglas Gunzler ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Care ◽  
Smoking Status ◽  
Health Care Systems ◽  
Patient Characteristics ◽  
Care Practice ◽  
Scarce Resources ◽  
Wide Range ◽  
Care Systems ◽  
At Home

ABSTRACT Importance: Severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the associated coronavirus disease of 2019 (COVID-19) have presented immense challenges for health care systems. Many regions have struggled to adapt to disruptions to health care practice and employ systems that effectively manage the demand for services. Objective: To examine the effectiveness of the first five weeks of a 24/7 physician-staffed COVID-19 hotline. Design: Cohort study using electronic health records. Setting: A single large health care system in Northeast Ohio. Participants: During 5 weeks of operation, 10,112 patients called the hotline (callers) and were evaluated by a registered nurse (RN) using standardized protocols. Of these, 4,213 (42%) were referred for a physician telehealth visit (telehealth patients). The mean age of callers was 42 years. 67% were female, 51% white, and 46% were on Medicaid or uninsured. Intervention: Physician telehealth visits for COVID-19. Main Outcomes and Measures: We describe clinical diagnosis, patient characteristics (age, sex race/ethnicity, smoking status, insurance status), and visit disposition. We use logistic regression to evaluate associations between patient characteristics, visit disposition and subsequent emergency department use, hospitalization, and SARS-Cov-2 PCR testing. Results: Common caller concerns included cough, fever, and shortness of breath. Most telehealth patients (79%) were advised to self-isolate at home, 14% were determined to be unlikely to have COVID-19, 3% were advised to seek emergency care, and 4% had miscellaneous other dispositions. A total of 287 (7%) patients had a subsequent ED visit, and 44 (1%) were hospitalized with a COVID-19 diagnosis. Of the callers, 482 (5%) had a COVID-19 test reported with 69 (14%) testing positive. Among patients advised to stay at home, 83% had no further face-to-face visits. In multivariable results, only a physician recommendation to seek emergency care was associated with emergency room use (OR=4.73, 95%CI 1.37-16.39, p=.014). Only older age was associated with having a positive test result. Conclusions and Relevance: Robust, physician-directed telehealth services can meet a wide range of needs during the acute phase of a pandemic, conserving scarce resources such as personal protective equipment and testing supplies and preventing the spread of infections to patients and health care workers.

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