Dataset Information

Systems approach to health service design, delivery and improvement: a systematic review and meta-analysis.

ABSTRACT:

Objectives

To systematically review the evidence base for a systems approach to healthcare design, delivery or improvement.

Design

Systematic review with meta-analyses.

Methods

Included 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 I² statistics.

Results

Of 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%).

Conclusions

This 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.

SUBMITTER: Komashie A

PROVIDER: S-EPMC7817809 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

Systems approach to health service design, delivery and improvement: a systematic review and meta-analysis.

Komashie Alexander A Ward James J Bashford Tom T Dickerson Terry T Kaya Gulsum Kubra GK Liu Yuanyuan Y Kuhn Isla I Günay Aslι A Kohler Katharina K Boddy Nicholas N O'Kelly Eugenia E Masters Joseph J Dean John J Meads Catherine C Clarkson P John PJ

BMJ open 20210119 1

<h4>Objectives</h4>To systematically review the evidence base for a systems approach to healthcare design, delivery or improvement.<h4>Design</h4>Systematic review with meta-analyses.<h4>Methods</h4>Included 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 incep ...[more]

PMID: 33468455

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Project description:IntroductionGoal planning is routinely employed in mental health service delivery to identify priorities for treatment and support the achievement and evaluation of outcomes. Previous systematic reviews of the literature have focused on the use of goal planning in a range of physical and cognitive disability settings, but there is a lack of information regarding how goal planning is used in mental healthcare.AimsThis systematic integrative review aimed to understand the types of goals, effectiveness of goal planning, the experience of goal planning and barriers and facilitators to effective goal planning in mental healthcare settings.MethodsFive databases were systematically searched using key terms related to mental health AND goal planning. The search was supplemented through citation chaining. Due to the heterogeneity of the studies, a narrative synthesis approach to data analysis was undertaken.ResultsFifty-four studies were identified through the search of the literature following the PRISMA guidelines. Data was systematically extracted and thematically organized. There was a high level of heterogeneity among the studies, originating from a range of countries and with diverse characteristics and focus. Four themes emerged from the data analysis and included: (i) goal planning as a central aspect of interventions; (ii) types of goals planned; (iii) factors that influenced goal planning and/or attainment; and (iv) collaboration and concordance in goal planning.ConclusionThis review found some support for the use of goal planning to improve outcomes in mental healthcare although there was no identified standardized approach to the use of goal planning. Individualized, recovery-oriented and collaborative goal planning was recommended but not always used in practice. Further research to understanding the most appropriate skills and training needed to support collaborative and effective goal planning is needed.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42020220595].

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Dataset Information

Systems approach to health service design, delivery and improvement: a systematic review and meta-analysis.

Objectives

Design

Methods

Results

Conclusions

Publications

Systems approach to health service design, delivery and improvement: a systematic review and meta-analysis.

Similar Datasets

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