Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Johns Hopkins Global Digital Health Initiative, Baltimore, MD, USA.
Glob Health Sci Pract. 2018 Oct 10;6(Suppl 1):S61-S71. doi: 10.9745/GHSP-D-18-00229.
Delivery of high-quality efficient health services is a cornerstone of the global agenda to achieve universal health coverage. According to the World Health Organization, health service delivery is considered good when equitable access to a comprehensive range of high-quality health services is ensured within an integrated and person-centered continuum of care. However, good health service delivery can be challenging in low-resource settings. In this review, we summarize and discuss key advances in health service delivery, particularly in the context of using digital health strategies for mitigating human resource constraints.
The review updates the foundational systematic review conducted by Agarwal et al. in 2015. We used PubMed, EMBASE, and CINAHL to find relevant English-language peer-reviewed articles published 2018. Our search strategy for MEDLINE was based on MeSH (medical subject headings) terms and text words of key articles that we identified a priori. Our search identified 92 articles. After screening, we selected 24 articles for abstract review, of which only 6 met the eligibility criteria and were ultimately included in this review.
Despite encouraging advances in the evidence base on digital strategies for health service delivery, the current body of evidence is still quite limited in 3 main areas: the effectiveness of interventions on health outcomes, improvement in health system efficiencies for service delivery, and the human capacity required to implement and support digital health strategies at scale. Two particular areas, digital health-enhanced referral coordination and mobile clinical decision support systems, demonstrate considerable potential to improve the quality and comprehensiveness of care received by patients, but they require a greater level of standardization and an expanded scope of health worker engagement across the health system in order to scale them up effectively.
Additional research is urgently needed to inform the effectiveness of interventions on health outcomes, improvement in health system efficiencies, and cost-effectiveness of service delivery. In particular, more documentation and research on ways to standardize and engage health workers in digital referral and clinical decision support systems can provide the foundation needed to scale these promising approaches in low- and middle-income settings.
提供高质量、高效率的卫生服务是实现全民健康覆盖全球议程的基石。世界卫生组织认为，当在综合和以人为中心的护理连续体中确保公平获得全面的高质量卫生服务时，卫生服务提供被认为是良好的。然而，在资源匮乏的环境中，良好的卫生服务提供可能具有挑战性。在本综述中，我们总结和讨论了卫生服务提供方面的主要进展，特别是在利用数字卫生战略缓解人力资源限制方面。
本综述更新了 Agarwal 等人 2015 年进行的基础系统综述。我们使用 PubMed、EMBASE 和 CINAHL 查找 2018 年发表的相关英文同行评审文章。我们对 MEDLINE 的搜索策略基于 MeSH（医学主题词）术语和我们事先确定的关键文章的文本词。我们的搜索确定了 92 篇文章。经过筛选，我们选择了 24 篇文章进行摘要审查，其中只有 6 篇符合入选标准并最终被纳入本综述。
尽管数字战略在卫生服务提供方面取得了令人鼓舞的进展，但目前的证据基础在以下 3 个主要领域仍然相当有限：干预措施对健康结果的有效性、服务提供的卫生系统效率的提高，以及实施和支持数字卫生战略所需的人力。两个特别领域，数字健康增强的转诊协调和移动临床决策支持系统，显示出相当大的潜力，可以提高患者接受的护理质量和全面性，但它们需要更高水平的标准化和扩大卫生工作者在整个卫生系统中的参与范围，以便有效地扩大规模。
迫切需要开展更多研究，以了解干预措施对健康结果的有效性、卫生系统效率的提高以及服务提供的成本效益。特别是，需要更多关于如何标准化和使卫生工作者参与数字转诊和临床决策支持系统的文件和研究，为在中低收入国家扩大这些有前途的方法提供必要的基础。
