Innovative models of healthcare delivery: an umbrella review of reviews

• Published in: BMJ open Vol. 13; no. 2; p. e066270
• Main Authors: Roberts, Natalie, Carrigan, Ann, Clay-Williams, Robyn, Hibbert, Peter D, Mahmoud, Zeyad, Pomare, Chiara, Fajardo Pulido, Diana, Meulenbroeks, Isabelle, Knaggs, Gilbert Thomas, Austin, Elizabeth E, Churruca, Kate, Ellis, Louise A, Long, Janet C, Hutchinson, Karen, Best, Stephanie, Nic Giolla Easpaig, Brona, Sarkies, Mitchell N, Francis Auton, Emilie, Hatem, Sarah, Dammery, Genevieve, Nguyen, Mai-Tran, Nguyen, Hoa Mi, Arnolda, Gaston, Rapport, Frances, Zurynski, Yvonne, Maka, Katherine, Braithwaite, Jeffrey
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 23-02-2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Adult; Ambulatory care; Asthma; Business administration; Child; Chronic Disease; Chronic illnesses; Chronic obstructive pulmonary disease; Consumers; Content analysis; dialysis; Health care delivery; Health Services Research; heart failure; Hospitals; Humanities and Social Sciences; Humans; Integrated delivery systems; Kidney diseases; Librarians; Patient Acceptance of Health Care; public health; Quality of Life; Self Care; Telemedicine; dialysis; heart failure; telemedicine; public health
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-066270

ObjectiveTo undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals.DesignUmbrella review.SettingInterventions delivered inside and outside of acute care settings.ParticipantsChildren and adults with one or more identified acute or chronic health conditions.Data sourcesPsycINFO, Ovid MEDLINE and CINAHL.Primary and secondary outcome measuresClinical indicators and mortality, healthcare utilisation, quality of life, self-management and self-care and patient knowledge.ResultsA total of 66 reviews were included, synthesising evidence from 1272 primary studies across the 7 models of care. Virtual care was the most common model studied, addressed by 47 (73%) of the reviews. Common outcomes evaluated across reviews were clinical indicators and mortality, healthcare utilisation, self-care and self-management, patient knowledge, quality of life and cost-effectiveness. The findings indicate that the innovative models of healthcare we identified in this review may be effective in managing patients with a range of acute and chronic conditions. Most of the included reviews reported evidence of comparable or improved care.ConclusionsA consideration of local infrastructure and individual patient characteristics, such as health literacy, may be critical in determining the suitability of models of care for patients and their implementation in local health systems.Trial registration number10.17605/OSF.IO/PS6ZU.