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A Systematic Assessment of the impacts of integrated healthcare in UK – Pubrica
The
NHS Five Year Forward View Plan, issued in 2014, outlines how services must
evolve and emphasizes the need for greater care integration. Increased service
integration, it is suggested, will enable the NHS to develop a financially
sustainable health and social care system by 2020. More care beyond the
hospital walls, changes in the size and design of acute hospitals, and
increased attention to prevention and public health are goals of the new
integrated care model. This systematic
review aimed at the effects of these new integration models and research
into whether models used in other care systems may achieve similar results in
the UK National Health Service setting.
Methods
Complex
system-wide projects, such as integrated care models, provide substantial
challenges for systematic
review approaches. Randomized
experimental trials, known as the "gold
standard," have historically been employed in systematic reviews to look for unambiguous
intervention-outcome effects. However, there has been significant growth in the
number of review methods accessible in recent years. It has become evident that
different review types are best for addressing additional questions and
fulfilling different aims.
Literature Review search strategy
The
study protocol was registered with the PROSPERO database and available on the
National Institute for Health Research website. The conducting
of literature review
was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analyses) guidelines.
Guidelines
from the Cochrane Collaboration, the Institute for Quality and Efficiency in Health
Care, and the NHS Economic Evaluation Database were used in this systematic review
research. We used Medline, Embase, ISI Web of Knowledge,
Cochrane Database of Systematic
Reviews, and Scopus to search five databases. In each database,
twenty-five expressions were entered (see supplementary material). We also used
Google to search the Internet, contacted specialists, and evaluated reference
lists.
Collecting data for Literature
Review
Three
reviewers assessed publication titles and abstracts (where available) against
the inclusion/exclusion criteria after the citations were submitted to an
EndNote database. The entire team discussed any issues about inclusion at
regular (fortnightly) team meetings.
Evaluation of the risk of bias
The hierarchy of research
design and various checklists for each study type were
utilized to assess quality. We investigated for sources of potential bias in
studies that employed a comparative method using the Cochrane criteria
(selection bias, performance bias, attrition bias, detection bias, reporting
bias). We followed the National Institutes of Health recommendations when using
studies before and after (pre-post) designs with no comparison group or
published systematic reviews.
Elements of models of integrated
care
The majority of the integrated care models
considered were multi-element and sophisticated interventions. The elements
within them could be divided into four categories: first, those aimed at
directly improving patient care; second, those aimed at changing organizations
and systems; third, those aimed at changing staff employment or working
practices; and finally, those aimed at financial or governance aspects of
integration.
Conclusion
Pubrica encourages systematic review services, although the evidence
for other objectives such as service costs is uncertain, integrated care models
may improve patient happiness, raise the perceived quality of care, and permit
access to services. Improved access might significantly impact services that fail
to meet rising demand.
Reference : https://bit.ly/3IqcDht
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