Heyeres Marion, McCalman Janya, Tsey Komla, Kinchin Irina
The Cairns Institute, James Cook University , Cairns, QLD , Australia.
School of Human Health and Social Sciences, Central Queensland University , Cairns, QLD , Australia.
Front Public Health. 2016 Oct 17;4:223. doi: 10.3389/fpubh.2016.00223. eCollection 2016.
The aim of health service integration is to provide a sustainable and integrated health system that better meets the needs of the end user. Yet, definitions of health service integration, methods for integrating health services, and expected outcomes are varied. This review was commissioned by Queensland Health, the government department responsible for health service delivery in Queensland, Australia, to inform efforts to integrate their mental health services. This review reports on the characteristics, reported outcomes, and design quality of studies included in systematic reviews of health service integration research.
The review was developed by systematically searching nine electronic databases to find peer-reviewed Australian and international systematic reviews with a focus on health service integration. Reviews were included if they were in the English language and published between 2000 and 2015. A standardized assessment tool was used to analyze the study design quality of included reviews. Data relating to the integration types, methods, and reported outcomes of integration were synthesized.
Seventeen publications met the inclusion criteria. Eleven (65%) reviews were published during the past 5 years, which may indicate a trend for increased awareness of the need for service integration. The majority of reviews were published by researchers in the UK (8/47%), USA (3/18%), and Australia (3/18%). Included reviews focused on a variety of integration types, including integrated care pathways, governance models, integration of interventions, collaborative/integrated care models, and integration of different types of health care. Most (53%) of the reviews reported on the cost-effectiveness of service integration, e.g., positive results, no effect, or inconclusive. Only one of the reviews reported on the importance of consumer involvement. The overall design of 70% of the reviews was high, 18% medium, and 12% low.
There is no "one size fits all" approach to health service integration. Instead, this literature review highlighted the complexity of service integration, which in most primary studies involved a range of strategies. Rigorous assessments of cost-effectiveness and reporting on consumer involvement are required in future research.
卫生服务整合的目标是提供一个可持续且综合的卫生系统，以更好地满足终端用户的需求。然而，卫生服务整合的定义、整合卫生服务的方法以及预期结果各不相同。本综述由澳大利亚昆士兰州负责卫生服务提供的政府部门昆士兰卫生厅委托开展，旨在为其整合心理健康服务的工作提供参考。本综述报告了卫生服务整合研究系统评价中所纳入研究的特征、报告的结果以及设计质量。
通过系统检索九个电子数据库来开展本综述，以查找侧重于卫生服务整合的经同行评审的澳大利亚和国际系统评价。纳入的综述需为英文且发表于2000年至2015年之间。使用标准化评估工具分析所纳入综述的研究设计质量。对与整合类型、方法以及报告的整合结果相关的数据进行了综合分析。
17篇出版物符合纳入标准。其中11篇（65%）综述发表于过去5年，这可能表明人们对服务整合需求的认识呈上升趋势。大多数综述由英国（8/47%）、美国（3/18%）和澳大利亚（3/18%）的研究人员发表。所纳入的综述关注多种整合类型,包括综合护理路径、治理模式、干预措施整合、协作/综合护理模式以及不同类型卫生保健的整合。大多数（53%）综述报告了服务整合的成本效益，例如积极结果、无效果或尚无定论。只有一篇综述报告了消费者参与的重要性。70%的综述总体设计质量高，18%中等，12%低。
卫生服务整合不存在“一刀切”的方法。相反，本综述强调了服务整合的复杂性，在大多数初步研究中涉及一系列策略。未来研究需要对成本效益进行严格评估并报告消费者参与情况。
