Systems approach to health service design, delivery and improvement: a systematic review and meta-analysis
| Autor: | T. Dickerson, Joseph Masters, Catherine Meads, Alexander Komashie, Katharina Kohler, Nicholas Boddy, Tom Bashford, John Dean, Isla Kuhn, Yuanyuan Liu, P. John Clarkson, Gulsum Kubra Kaya, James Ward, Eugenia O'Kelly, Aslι Günay |
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| Přispěvatelé: | Komashie, Alexander [0000-0002-0715-4729], Bashford, Tom [0000-0003-0228-9779], Kaya, Gulsum Kubra [0000-0003-0663-3995], Liu, Yuanyuan [0000-0003-2331-2392], Günay, Aslι [0000-0002-5261-5889], Kohler, Katharina [0000-0003-1919-0193], O'Kelly, Eugenia [0000-0002-4748-3957], Meads, Catherine [0000-0002-2368-0665], Clarkson, P John [0000-0001-8018-7706], Apollo - University of Cambridge Repository |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Systems Analysis MEDLINE Psychological intervention lcsh:Medicine CINAHL PsycINFO organisation of health services quality in health care 03 medical and health sciences 0302 clinical medicine Health care Medicine Health services research Humans 030212 general & internal medicine Health policy Qualitative Research business.industry 030503 health policy & services lcsh:R health policy General Medicine Health Services Meta-analysis Family medicine 0305 other medical science business Delivery of Health Care |
| Zdroj: | BMJ Open, Vol 11, Iss 1 (2021) BMJ Open |
| ISSN: | 2044-6055 |
| DOI: | 10.17863/cam.63711 |
| Popis: | ObjectivesTo systematically review the evidence base for a systems approach to healthcare design, delivery or improvement.DesignSystematic review with meta-analyses.MethodsIncluded were studies in any patients, in any healthcare setting where a systems approach was compared with usual care which reported quantitative results for any outcomes for both groups. We searched Medline, Embase, HMIC, Health Business Elite, Web of Science, Scopus, PsycINFO and CINAHL from inception to 28 May 2019 for relevant studies. These were screened, and data extracted independently and in duplicate. Study outcomes were stratified by study design and whether they reported patient and/or service outcomes. Meta-analysis was conducted with Revman software V.5.3 using ORs—heterogeneity was assessed using I2statistics.ResultsOf 11 405 records 35 studies were included, of which 28 (80%) were before-and-after design only, five were both before-and-after and concurrent design, and two were randomised controlled trials (RCTs). There was heterogeneity of interventions and wide variation in reported outcome types. Almost all results showed health improvement where systems approaches were used. Study quality varied widely. Exploratory meta-analysis of these suggested favourable effects on both patient outcomes (n=14, OR=0.52 (95% CI 0.38 to 0.71) I2=91%), and service outcomes (n=18, OR=0.40 (95% CI 0.31 to 0.52) I2=97%).ConclusionsThis study suggests that a systems approaches to healthcare design and delivery results in a statistically significant improvement to both patient and service outcomes. However, better quality studies, particularly RCTs are needed.PROSPERO registration numberCRD42017065920. |
| Databáze: | OpenAIRE |
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