Evidence map›Paper›PMID 33468455›Full record

SynthesisBMJ open2021

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

Alexander Komashie, James Ward, Tom Bashford, Terry Dickerson, Gulsum Kubra Kaya, Yuanyuan Liu, Isla Kuhn, Aslι Günay, Katharina Kohler, Nicholas Boddy and 5 more

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
53citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

53 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Article
  6. Article
  7. Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Review
  19. Article
  20. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Alexander KomashieDepartment of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK A.Komashie@eng.cam.ac.uk.ORCID 0000-0002-0715-4729
James WardDepartment of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK.
Tom BashfordDepartment of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK.ORCID 0000-0003-0228-9779
Terry DickersonDepartment of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK.
Gulsum Kubra KayaFaculty of Engineering and Natural Sciences, Istanbul Medeniyet University, Istanbul, Turkey.ORCID 0000-0003-0663-3995
Yuanyuan LiuDepartment of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK.ORCID 0000-0003-2331-2392
Isla KuhnSchool of Clinical Medicine, University of Cambridge, Cambridge, UK.
Aslι GünayDepartment of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK.ORCID 0000-0002-5261-5889
Katharina KohlerDepartment of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK.ORCID 0000-0003-1919-0193
Nicholas BoddyDepartment of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK.
Eugenia O'KellyDepartment of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK.ORCID 0000-0002-4748-3957
Joseph MastersMajor Trauma Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK.
John DeanDepartment of Care Quality Improvement, Royal College of Physicians, London, London, UK.
Catherine MeadsSchool of Nursing and Midwifery, Anglia Ruskin University - Cambridge Campus, Cambridge, Cambridgeshire, UK.ORCID 0000-0002-2368-0665
P John ClarksonDepartment of Engineering, University of Cambridge, Cambridge, Cambridgeshire, UK.ORCID 0000-0001-8018-7706

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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 I

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) I

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.

Indexed as

Delivery of Health CareHealth ServicesHumansQualitative ResearchSystems Analysishealth policyorganisation of health servicesquality in health care

Identifiers

PMID33468455
PMCPMC7817809

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.