La Trobe University, School of Allied Health, Human Services and Sport, Melbourne, Victoria, Australia.
Eastern Health Allied Health Clinical Research Office, Box Hill, Victoria, Australia.
Health Soc Care Community. 2022 Nov;30(6):2057-2070. doi: 10.1111/hsc.13866. Epub 2022 Jun 18.
Despite well-documented benefits of rehabilitation and therapy services for children with disabilities, long waiting lists to access these services are common. There is a growing body of evidence, primarily from mixed or adult services, demonstrating that waiting times can be reduced through strategies that target wasteful processes and support services to keep up with demand. However, providers of rehabilitation and therapy services for children face additional complexities related to the long-term nature of many developmental conditions and the need to consider timing of interventions with developmental milestones and education transition points. This review aimed to synthesise available evidence on service redesign strategies in reducing waiting time for paediatric therapy services. We conducted a systematic review of studies conducted in outpatient paediatric rehabilitation or therapy settings, including physical and mental health services, evaluating a service redesign intervention and presenting comparative data on time to access care. Two reviewers independently applied inclusion criteria, assessed risk of bias and extracted data. Findings were analysed descriptively and the certainty of evidence was synthesised according to criteria for health service research. From 1934 studies identified, 33 met the criteria for inclusion. Interventions were categorised as rapid response strategies, process efficiency interventions or substitution strategies (using alternative providers in place of medical specialists). Reductions in waiting time were reported in 30 studies. Evidence is limited by study designs with high risk of bias, but this is mitigated by consistency of findings and large effect sizes. There is moderate-certainty evidence that service redesign strategies similar to those used in adult populations can be applied in paediatric rehabilitation and therapy settings to reduce waiting time.
尽管康复和治疗服务对残疾儿童有明确的益处，但长期等待这些服务的情况很常见。越来越多的证据主要来自混合或成人服务，表明通过针对浪费流程和支持服务以满足需求的策略，可以减少等待时间。然而，儿童康复和治疗服务的提供者面临着与许多发育状况的长期性以及考虑干预措施与发育里程碑和教育过渡点的时间相关的额外复杂性。本次综述旨在综合现有的关于服务重新设计策略的证据，以减少儿科治疗服务的等待时间。我们对在门诊儿科康复或治疗环境中进行的研究进行了系统综述，包括身体和心理健康服务，评估了服务重新设计干预措施，并提供了关于获得护理的时间的比较数据。两名评审员独立应用纳入标准、评估偏倚风险并提取数据。结果进行了描述性分析，并根据卫生服务研究标准综合了证据的确定性。从确定的 1934 项研究中，有 33 项符合纳入标准。干预措施分为快速反应策略、流程效率干预或替代策略（用替代医疗专家的替代提供者替代）。30 项研究报告了等待时间的减少。研究设计的偏倚风险高，限制了证据，但研究结果的一致性和大的效应量减轻了这种影响。有中等确定性的证据表明，类似于成人人群中使用的服务重新设计策略可以应用于儿科康复和治疗环境中，以减少等待时间。
