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. 2022 Apr;28(2):208-217.
doi: 10.1111/jep.13613. Epub 2021 Aug 17.

Measuring performance of professional role substitution models of care against traditional medical care in healthcare-A systematic review

Rumbidzai N Mutsekwa  1   2 , Charlene Wright  2   3 , Joshua M Byrnes  2   3 , Russell Canavan  4 , Rebecca L Angus  1   5 , Alan Spencer  1 , Katrina L Campbell  2   3   6
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Measuring performance of professional role substitution models of care against traditional medical care in healthcare-A systematic review

Rumbidzai N Mutsekwa et al. J Eval Clin Pract. 2022 Apr.

Abstract

Objectives: To identify outcome measures used to evaluate performance of healthcare professional role substitution against usual medical doctor or specialist medical doctor care to facilitate our understanding of the adequacy of these measures in assessing quality of healthcare delivery.

Methods: Using a systematic approach, we searched Medline, Cochrane Central Register of Controlled Trials, Embase, CINAHL, and Web of Science from database inception until May 2020. Studies that presented original comparative data on at least one outcome measure were included following screening by two authors. Findings were synthesized, and outcome measures classified into six domains which included: effectiveness, safety, appropriateness, access, continuity of care, efficiency, and sustainability which were informed by the Institute of Medicine dimensions of healthcare quality, the Australian health performance framework, and Levesque and Sutherland's integrated performance measurement framework.

Results: One thirty five articles met the inclusion criteria, describing 58 separate outcome measures. Safety of role substitution models of care was assessed in 80 studies, effectiveness (n = 60), appropriateness (n = 40), access (n = 36), continuity of care (n = 6), efficiency and productivity (n = 45). Two-thirds of the studies that assessed productivity and efficiency performed an economic analysis (n = 27). The quality and rigour of evaluations varied substantially across studies, with two-thirds of all studies measuring and reporting outcomes from only one or two of these domains.

Conclusions: There are a growing number of studies measuring the performance of non-medical healthcare professional substitution roles. Few have been subject to robust evaluations, and there is limited evidence on the scientific rigour and adequacy of outcomes measured. A systematic and coordinated approach is required to support healthcare settings in assessing the value of non-medical role substitution healthcare delivery models.

Keywords: outcome measures; performance; professional role substitution.

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References

REFERENCES

    1. Siciliani L, Hurst J. Tackling excessive waiting times for elective surgery: a comparative analysis of policies in 12 OECD countries. Health Policy. 2005;72:201-215.
    1. Duckett SJ. Health workforce design for the 21st century. Aust Health Rev. 2005;29:201-210.
    1. Segal L, Bolton T. Issues facing the future health care workforce: the importance of demand modelling. Aust New Zealand Health Policy. 2009;6:12.
    1. Baker A. Crossing the Quality Chasm: A New Health System for the 21st Century. Vol 323. Washington, DC: National Academy Press; 2001.
    1. Owens DK, Qaseem A, Chou R, Shekelle P, Clinical Guidelines Committee of the American College of Physicians. High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions. Ann Intern Med. 2011;154:174-180.

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