School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
BMC Med. 2020 May 20;18(1):117. doi: 10.1186/s12916-020-01580-3.
Reconfiguration of urgent and emergency care services often increases travel time/distance for patients to reach an appropriate facility. Evidence of the effects of reconfiguration is important for local communities and commissioners and providers of health services.
We performed a systematic review of the evidence regarding effects of service reconfigurations that increase the time/distance for some patients to reach an urgent and emergency care (UEC) facility. We searched seven bibliographic databases from 2000 to February 2019 and used citation tracking and reference lists to identify additional studies. We included studies of any design that compared outcomes for people with conditions requiring emergency treatment before and after service reconfiguration with an associated change in travel time/distance to access UEC. Studies had to be conducted in the UK or other developed countries. Data extraction and quality assessment (using the Joanna Briggs Institute checklist for quasi-experimental studies) were undertaken by a single reviewer with a sample checked for accuracy and consistency. We performed a narrative synthesis of the included studies. Overall strength of evidence was assessed using a previously published method that considers volume, quality and consistency.
We included 12 studies, of which six were conducted in the USA, two in the UK and four in other European countries. The studies used a variety of observational designs, with before-after and cohort designs being most common. Only two studies included an independent control site/sites where no reconfiguration had taken place. The reconfigurations evaluated in these studies reported relatively small effects on average travel times/distance.
For studies of general UEC populations, there was no convincing evidence as to whether reconfiguration affected mortality risk. However, evidence of increased risk was identified from studies of patients with acute myocardial infarction, particularly 1 to 4 years after reconfiguration. Evidence for other conditions was inconsistent or very limited.
We found insufficient evidence to determine whether increased distance to UEC increases mortality risk for the general population of people requiring UEC, although this conclusion may not extend to people with specific conditions.
紧急和急救护理服务的重新配置通常会增加患者到达适当医疗机构的旅行时间/距离。重新配置效果的证据对当地社区以及卫生服务的管理者和提供者都很重要。
我们对增加一些患者到达紧急和急救护理（UEC）设施的时间/距离的服务重新配置效果的证据进行了系统评价。我们从 2000 年到 2019 年 2 月在七个书目数据库中进行了搜索，并使用引文跟踪和参考文献列表来确定其他研究。我们纳入了任何设计的研究，这些研究比较了服务重新配置前后需要紧急治疗的患者的结果，以及到达 UEC 的旅行时间/距离的变化。研究必须在英国或其他发达国家进行。数据提取和质量评估（使用 Joanna Briggs Institute 用于准实验研究的清单）由一名审查员进行，对样本进行了准确性和一致性检查。我们对纳入的研究进行了叙述性综合。使用先前发布的方法评估了总体证据强度，该方法考虑了数量、质量和一致性。
我们纳入了 12 项研究，其中 6 项在美国进行，2 项在英国进行，4 项在其他欧洲国家进行。这些研究使用了各种观察性设计，以前后设计和队列设计最为常见。只有两项研究包括一个独立的对照组/没有进行重新配置的对照组。这些研究评估的重新配置平均对旅行时间/距离的影响相对较小。
对于一般 UEC 人群的研究，没有令人信服的证据表明重新配置是否会影响死亡率风险。然而，从急性心肌梗死患者的研究中发现了增加风险的证据，特别是在重新配置后 1 至 4 年内。其他条件的证据不一致或非常有限。
我们发现，没有足够的证据来确定增加 UEC 的距离是否会增加一般需要 UEC 的人群的死亡率风险，尽管这一结论可能不适用于特定条件的人群。
