Faculty of Health Sciences, University of Brasilia, Brasília, Brazil.
Oswaldo Cruz Foundation, Brasília, Brazil.
PLoS One. 2020 Dec 22;15(12):e0244078. doi: 10.1371/journal.pone.0244078. eCollection 2020.
Regionalization is the integrated organization of a healthcare system, wherein regional structures are responsible for providing and administrating health services in a specific region. This method was adopted by several countries to improve the quality of provided care and to properly utilize available resources. Thus, a systematic review was conducted to verify effective interventions to improve health and management indicators within the health services regionalization. The protocol was registered in PROSPERO (CRD42016042314). We performed a systematic search in databases during February and March 2017 which was updated in October 2020. There was no language or date restriction. We included experimental and observational studies with interventions focused on regionalization-related actions, measures or policies aimed at decentralizing and organizing health offerings, rationalizing scarce capital and human resources, coordinating health services. A methodological assessment of the studies was performed using instruments from the Joanna Briggs Institute and GRADE was also used to assess outcomes. Thirty-nine articles fulfilled the eligibility criteria and sixteen interventions were identified that indicated different degrees of recommendations for improving the management of health system regionalization. The results showed that regionalization was effective under administrative decentralization and for rationalization of resources. The most investigated intervention was the strategy of concentrating procedures in high-volume hospitals, which showed positive outcomes, especially with the reduction of hospitalization days and in-hospital mortality rates. When implementing regionalization, it must be noted that it involves changes in current standards of health practice and in the distribution of health resources, especially for specialized services.
区域化是医疗体系的综合组织，其中区域结构负责在特定区域内提供和管理卫生服务。一些国家采用这种方法是为了提高提供的护理质量并合理利用现有资源。因此，进行了系统评价，以验证改善卫生服务区域化的健康和管理指标的有效干预措施。该方案已在 PROSPERO（CRD42016042314）中注册。我们于 2017 年 2 月至 3 月在数据库中进行了系统搜索，并于 2020 年 10 月进行了更新。没有语言或日期限制。我们纳入了以区域化相关行动、措施或政策为重点的干预措施的实验和观察性研究，旨在分散和组织卫生服务、合理配置稀缺资本和人力资源、协调卫生服务。使用 Joanna Briggs 研究所的工具对研究进行了方法评估，还使用 GRADE 评估了结果。有 39 篇文章符合入选标准，确定了 16 项干预措施，这些干预措施表明在改善卫生系统区域化管理方面有不同程度的建议。结果表明，行政权力下放和资源合理化条件下的区域化是有效的。调查最多的干预措施是将程序集中在高容量医院的策略，该策略显示出积极的结果，特别是在减少住院天数和住院死亡率方面。在实施区域化时，必须注意到它涉及到卫生实践当前标准和卫生资源分配的变化，特别是对于专科服务。
