Flinders Health and Medical Research Institute, Flinders University, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia. Email:
Aust Health Rev. 2020 Aug;44(4):557-562. doi: 10.1071/AH19188.
Objective Healthcare delivery models describe the organisation of healthcare practitioners and other resources to provide health care for a defined patient population. The organisation of health care has a predominant effect on the receipt of timely and appropriate health care. Efforts to improve healthcare delivery should be evidence informed, and large numbers of evaluations of healthcare delivery models have been undertaken. This paper presents a scoping review of Australian evaluations of new healthcare delivery models to inform a discussion of the appropriate use of such evidence to improve the efficiency and sustainability of the Australian health system. Methods A systematic scoping review was undertaken, following an a priori published protocol. PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for primary comparative studies of healthcare delivery models undertaken in Australia and published between 2009 and 2018. Primary prevention studies, such as health promotion activities, were excluded. Results Of 14923 citations, 636 studies were included in the scoping review. Of these, 383 (60%) were randomised control trials. There were 18 clinical specialties in which over 10 evaluations were identified. Most models involved allied health practitioners or nurses. Conclusion Evaluations of healthcare delivery models provide important evidence that can be used to improve the use of the most important and costly assets of health systems, namely the healthcare practitioners who deliver health care. A nationally coordinated system is required to support local health services to assess the local value of alternative healthcare delivery models. What is known about the topic? The organisation and delivery of health care is continuously evolving in response to changes in the demand and supply of health care. New healthcare delivery models are often evaluated in specific locations, but it is not clear how such evidence informs the delivery of care in other locations. What does this paper add? This paper reports the findings of a scoping review of Australian evaluations of healthcare delivery models, highlighting the large and increasing number of such evaluations that have been published in the past 10 years. What are the implications for practitioners? Opportunities to improve health system efficiency are likely being lost due to the underuse of the available Australian evidence on new healthcare delivery models. Local health services need support to interpret such evidence in their local context, which could be provided through the development of a national framework for local evaluation.
目的
医疗服务模式描述了医疗从业者和其他资源的组织方式，以向特定患者群体提供医疗服务。医疗保健的组织方式对及时和适当的医疗服务的提供有重要影响。改善医疗服务的努力应该以证据为基础，已经进行了大量医疗服务模式的评估。本文对澳大利亚新医疗服务模式评估进行了范围界定审查，为讨论适当利用这些证据提高澳大利亚卫生系统的效率和可持续性提供参考。
方法
按照事先制定的方案进行了系统的范围界定审查。在澳大利亚进行的、发表于 2009 年至 2018 年之间的医疗服务模式的比较性原始研究，在 PubMed、Embase 和 Cumulative Index to Nursing and Allied Health Literature (CINAHL) 数据库中进行了检索。主要预防研究（如健康促进活动）除外。
结果
在 14923 条引文中共纳入 636 项研究。其中，383 项（60%）为随机对照试验。有 18 个临床专业领域中确定了超过 10 项评估。大多数模式涉及辅助医疗从业者或护士。
结论
医疗服务模式的评估提供了重要证据，可以用于改善卫生系统最重要和最昂贵资产（即提供医疗服务的医疗从业者）的使用。需要建立一个全国性的协调系统，以支持当地卫生服务部门评估替代医疗服务模式的当地价值。
关于该主题已知的内容是什么？
随着医疗保健需求和供应的变化，医疗保健的组织和提供方式在不断发展。新的医疗服务模式通常在特定地点进行评估，但尚不清楚此类证据如何为其他地点的医疗服务提供信息。
本文增加了哪些内容？
本文报告了对澳大利亚医疗服务模式评估的范围界定审查结果，强调了过去 10 年中发表的此类评估数量的大量增加。
这对从业者意味着什么？
由于未能充分利用澳大利亚关于新医疗服务模式的现有证据，可能会错失提高卫生系统效率的机会。当地卫生服务部门需要支持来在当地背景下解释此类证据，可以通过制定国家框架来为本地评估提供支持。
