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Health-system arrangements

 

We are in the process of identifying and extracting decision-relevant information about the ‘best evidence syntheses’ for each element of the COVID-END sub-taxonomy focused on health-system arrangements. We will continue to add evidence syntheses to this webpage as we complete this work, and we will make adjustments on a bi-weekly basis to which evidence syntheses are profiled, and to the information made available about included reviews, as the evidence base evolves.

Broad and specific decisions Criteria for 'best evidence synthesis' Details to support relevance assessment Additional decision-relevant details Citation
Date of last search Quality (AMSTAR) rating Evidence profile Key findings
Living evidence synthesis Type of synthesis              Type of question
  Approach to population-health management for COVID-19 and for those whose care is disrupted by COVID-19                
    Segmenting the population into groups with shared health and social needs                
    Re-designing care pathways and in-reach and out-reach services 2020-03-30  2/9 No Surgeries should be posponed during the pandemic when feasible to reduce risk of infection and complications, while health personnel should carefully manage the use of operating theatres, and involve the smallest number of staff for emergency or necessary surgeries
No  Full review  Other  De Simone B, Chouillard E, Di Saverio S, et al. Emergency Surgery During the COVID-19 Pandemic: What You Need to Know for Practice. Ann R Coll Surg Engl 2020;102(5):323-332.
    Addressing barriers to implementation of pathways and services                
    Addressing cultural safety in the implementation of pathways and services                
    Maintaining gains made in population-health management (e.g., population segmentation, virtual care) and spreading and scaling them                
Delivery arrangements                
  Service planning for COVID-19 prevention                
    Changing emergency-medical service procedures (ambulances, paramedics)                
    Re-locating hospital-based ambulatory clinics, cancer treatments, etc.                
    Limiting access to health facilities                
    Changing hospital-discharge procedures                
    Changing long-term care procedures 2020-05-29
7/10  Yes  Outbreak investigations show that long-term care facilities are more vulnerable to the COVID-19 pandemic, in terms of disease spread and mortality rate  Yes Full review  Other  Salcher-Konrad M, Jhass A, Naci H, Tan M, El-Tawil Y, Comas-Herrera A. COVID-19 Related Mortality and Spread of Disease in Long-Term Care: First Findings from a Living Systematic Review of Emerging Evidence. MedRxiv 2020. 
    Changing home and community care procedures                
  Service planning for COVID-19 treatment                
    Scaling up/down testing capacity                
    Scaling up/down emergency-room capacity                
    Scaling up/down ICU capacity 2020-03-30
2/9 No  Decisions to perform surgery should be carefully evaluated based on availability of ICU capacity in contexts where operational theatres have been converted into temporary ICUs for COVID-19 patients  No  Full review  Other  De Simone B, Chouillard E, Di Saverio S, et al. Emergency Surgery During the COVID-19 Pandemic: What You Need to Know for Practice. Ann R Coll Surg Engl 2020;102(5):323-332. 
    Scaling up/down post-ICU recovery capacity (e.g., hospital beds)                
    Scaling up/down palliative-care capacity                
    Scaling up/down COVID-19 sequelae-management capacity                
    Scaling up/down capacity to manage the pandemic-related impacts on health more generally (e.g., mental health and addictions)                
    Surge-management models                
    Triage protocols 2020-03-30 2/9 No  The use of triage protocols can support assessments of patient severity and help to decide whether surgery is necessary or can be delayed with non-surgical management during the COVID-19 pandemic  No  Full review  Other  De Simone B, Chouillard E, Di Saverio S, et al. Emergency Surgery During the COVID-19 Pandemic: What You Need to Know for Practice. Ann R Coll Surg Engl 2020;102(5):323-332. 
      2020-03-26
7/9  Yes  Key factors affecting adherence to infection prevention and control guidelines among healthcare workers include their design and content, how they are communicated, and whether there is adequate organizational support, training, and access to personal prot   No Rapid review  Other  Houghton C, Meskell P, Delaney H, et al. Barriers and Facilitators to Healthcare Workers' Adherence with Infection Prevention and Control (IPC) Guidelines for Respiratory Infectious Diseases: a Rapid Qualitative Evidence Synthesis. Cochrane Database Syst Rev 2020;4(4):CD013582. 
    Infection prevention and control measures in health facilities 2020-04-01
9/10  No  It is uncertain whether facial barriers alone are effective without other measures to reduce the spread of respiratory viruses  No  Full review  Benefits and harms  Jefferson T, Jones M, Al Ansari L, Bawazeer G, Beller E, Clark J, et al. Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses. Part I - Face Masks, Eye Protection and Person Distancing: Systematic Review and Meta-Analysis. MedRxiv 2020. 
      2020-04-24
6/10  No  No use of PPE by healthcare workers (including masks, gloves, gowns and eye protection) is consistently associated with an increasing risk of corinavirus infection  Yes Full review  Benefits and harms  Chou R, Dana T, Buckley D, Selph S, Fu R, Totten A. Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers. Ann Intern Med 2020; M20-1632. 
      2020-04-02
5/9  No  The risk of contracting SARS-Cov-2 through surgical smoke cannot be excluded, so healthcare personnel need to adopt all required protective strategies, including preoperative testing  No Full review  Other  Pavan N, Crestani A, Abrate A, et al. Risk of Virus Contamination Through Surgical Smoke During Minimally Invasive Surgery: A Systematic Review of Literature on a Neglected Issue Revived in the COVID-19 Pandemic Era. Eur Urol Focus. 2020;S2405-4569(20)30156-5. 
    Death certification                
    Handling dead bodies                
  Service planning for the ongoing management of other conditions                
    Changing acute care surgery and trauma-care procedures 2020-03-30
2/9  No  Emergency surgeons need to maintain a high standard of care through assessments of surgical necessity and oversight of the implementation of risk-prevention measures in the operating theatre  No  Full review  Other  De Simone B, Chouillard E, Di Saverio S, et al. Emergency Surgery During the COVID-19 Pandemic: What You Need to Know for Practice. Ann R Coll Surg Engl 2020;102(5):323-332. 
    Changing cancer-treatment procedures 2020-04-17
6/9 No There is consistency among urology guidelines that certain services can be postponed, including for low-risk cancers   No  Full review Other Heldwein FL, Loeb S, Wroclawski ML, et al. A Systematic Review on Guidelines and Recommendations for Urology Standard of Care During the COVID-19 Pandemic. Eur Urol Focus. 2020;S2405-4569(20)30155-3. 
    Delaying return visits, elective procedures, etc. 2020-03-30
2/9  No  Emergency surgeons should complete a comprehensive risk assessment when deciding whether to postpone surgical procedures  No  Full review  Other  De Simone B, Chouillard E, Di Saverio S, et al. Emergency Surgery During the COVID-19 Pandemic: What You Need to Know for Practice. Ann R Coll Surg Engl 2020;102(5):323-332. 
      2020-04-17
6/9  No  There is consistency among urology guidelines that certain services can be postponed, including for low-risk endourological conditions  No  Full review  Other  Heldwein FL, Loeb S, Wroclawski ML, et al. A Systematic Review on Guidelines and Recommendations for Urology Standard of Care During the COVID-19 Pandemic. Eur Urol Focus. 2020;S2405-4569(20)30155-3. 
  Infrastructure planning and resource allocation                
    Personal protective equipment (under shortage conditions), including N95 respirators for health workers                
    Ventilators for sick COVID-19 patients                
    Medications and other technologies (under shortage conditions due to disrupted supply chains)                
    Remote monitoring 2020-04-30  4/9  No  Patients who have received respiratory rehabilitation and have ongoing complications as a result of COVID-19 may require telemonitoring during the post-acute phase of their illness  Yes  Full review  Other  de Sire A, Andrenelli E, Negrini F, Negrini S, Ceravolo M. Systematic Rapid Living Review on Rehabilitation Needs Due to Covid-19: Update to April 30th 2020. Eur J Phys Rehabil Med 2020. 
    Virtual visits 2020-04-30
4/9  No  Patients who have received respiratory rehabilitation and have ongoing complications as a result of COVID-19 may require telerehabilitation during the post-acute phase of their illness  Yes  Full review  Other  de Sire A, Andrenelli E, Negrini F, Negrini S, Ceravolo M. Systematic Rapid Living Review on Rehabilitation Needs Due to Covid-19: Update to April 30th 2020. Eur J Phys Rehabil Med 2020. 
  Workforce planning (including workforce shortages management) and development                
    Recruitment                
    Role extensions                
    Training in new procedures                
    Replacements when sick                
    Movement-control strategies                
    Supports to unpaid caregivers                
    Volunteer engagement to support vulnerable populations                
    Self-management supports                
  Service planning for ‘return to normal’                
    Sequencing of services re-starting, by sector, conditions, treatments (including diagnostics), and populations                
    Wait-lists management                
Financial arrangements                
  Financing health services                
  Funding organizations                
  Remunerating providers                
    New or adjusted fee codes for virtual care                
    Income replacement when virtual care is not possible (at the same scale)                
  Purchasing products and services                
    Bulk purchasing                
Governance arrangements (who can make what decisions)                
  Consumer and stakeholder involvement                
  Professional authority                
    Licensure changes to accommodate out-of-jurisdiction or retired health workers                
  Commercial authority                
    Technology approvals, public-private partnerships                
  Organizational authority                
    Limits of number of staff sent in                
  Policy authority                
    Federal versus provincial                
    Adhering to the International Health Regulations