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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.<br><br>Reference : https://bit.ly/3IqcDht<br>Our services : https://pubrica.com/services/research-services/systematic-review/<br><br>
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ASystematicAssessmentof the Impacts of Integrated HealthcareinUK AnAcademicpresentationby Dr.NancyAgnes,Head,TechnicalOperations,Pubrica Group:www.pubrica.com Email:sales@pubrica.com
TODAY'SDISCUSSION Outline Methods LiteratureReviewsearchstrategy CollectingdataforLiteratureReview Evaluation ofthe risk of bias Elementsofmodelsofintegratedcare Conclusion
GrowingfinancialandservicedemandsintheUK National Health Service (NHS) have been argued to needatransformation inhealthand socialcare. The NHS Five Year Forward View Plan, issued in 2014, outlines how services must evolve and emphasizes the needfor greatercare integration. Increasedserviceintegration,itissuggested,will enabletheNHStodevelop afinanciallysustainable healthand socialcare system by2020. Contd...
More care beyond the hospital walls, changes in the size and design of acute hospitals, and increased attention to preventionandpublichealtharegoalsofthenew integratedcare 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 NationalHealth Servicesetting.
METHODS Complexsystem-wideprojects,suchasintegratedcare models, provide substantial challenges for systematic review approaches. Randomizedexperimentaltrials, standard,"havehistoricallybeen known employed asthe"gold insystematic reviews to look for unambiguous intervention-outcome effects. However,therehasbeensignificantgrowthinthenumberof reviewmethods accessible in recentyears. Ithasbecomeevidentthatdifferentreviewtypesarebestfor addressing additionalquestions andfulfilling differentaims. Contd...
To accomplish the three goals of analyzing various forms of integratedcareinitiativesandservicedeliveryresults, combining studies of varied designs across the hierarchy of evidence, and learning most relevant to the NHS in the UnitedKingdom, we useda proper reviewtechnique. As a result, we adopted a technique based on Pawson's work,whichemphasizesthenecessityofaccuracyand relevancewhen analyzing complexoutcome patterns. GuidelinesfromtheCochraneCollaboration,theInstitute forQualityandEfficiency in Health Care,andtheNHS EconomicEvaluationDatabasewereused inthis systematicreview research.
WeusedMedline,Embase,ISIWebofKnowledge,CochraneDatabaseofSystematicReviews, andScopus to search fivedatabases. Ineachdatabase,twenty-fiveexpressionswereentered(seesupplementarymaterial). WealsousedGoogletosearchtheInternet,contactedspecialists,andevaluatedreferencelists.
LITERATUREREVIEW SEARCHSTRATEGY ThestudyprotocolwasregisteredwiththePROSPEROdatabaseandavailableontheNational Institutefor Health Research website. TheconductingofliteraturereviewwasconductedaccordingtoPRISMA(PreferredReporting Items for Systematic Reviews and Meta-Analyses) guidelines.
COLLECTINGDATAFOR LITERATUREREVIEW Three reviewers assessed publication titles and abstracts (where available) against the inclusion/exclusion criteria after the citations weresubmitted to an EndNote database. The entire team discussed any issues about inclusion at regular (fortnightly)team meetings.
EVALUATIONOFTHERISKOFBIAS The hierarchy of research designand various checklists for each studytype were utilized to assess quality. Weinvestigatedforsourcesofpotentialbias instudiesthat employed acomparativemethodusingtheCochranecriteria (selectionbias,performancebias,attritionbias,detectionbias, reportingbias). We followed the National Institutes of Health recommendations when using studies before and after (pre-post) designs with no comparisongroup or published systematic reviews. Insteadof anumericalqualityindicator,wedidnotevaluate elementsbutoffered a narrative.
ELEMENTSOFMODELSOF INTEGRATEDCARE Themajorityoftheintegratedcaremodelsconsideredwere multi-elementand sophisticatedinterventions. Theelementswithinthemcouldbedividedintofour categories:first,thoseaimedatdirectlyimprovingpatient care;second,thoseaimedatchangingorganizationsand systems; third, those aimed at changing staff employment or workingpractices;andfinally,thoseaimedatfinancialor governanceaspects of integration. Due torestrictedreporting,manymodelsincludedmany elements,making itdifficult todeciphertheformand components.
We found the most elements in a single intervention to be nine, higher than comparable integrated careeffortswithonly one element. Models typically had four to six elements. In the international research, case manager/case co- coordinatorinitiatives weremorecommon,butintegrated carepathways/plans weremore commonin UKmodels.
CONCLUSION Pubricaencouragessystematicreviewservices, although the evidence for other objectives such as service costs is uncertain, integrated care models may improve patient happiness, raise the perceived qualityofcare,andpermitaccesstoservices. Improved access might significantly impact services thatfailto meetrising demand.
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