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Evidence about health-system arrangements (under construction)


We continue to add evidence syntheses to this webpage as we harvest and process weekly updates from ‘high-yield, high quality’ sources of evidence syntheses and as we add new sources. More details are available about the context for the inventory, our approach to developing and maintain it, and tips for using it. Similar webpages are available for evidence about public-health measures, the clinical management of COVID-19 and related conditions, and economic and social responses.

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 (e.g., GRADE) available 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              
    Addressing barriers to implementation of pathways and services N/A (Protocol)
n/a No [Protocol] A review on the factors affecting compliance with infant feeding practices to prevent respiratory infections is currently being conducted Yes (row content last updated on 2020-10-08) Protocol  Views and Experiences  Bick D, Fisher J, Chang Y, Sutcliffe P, Hillman S, Chien L. Barriers and Facilitators to Optimizing Parents’, Carers’ and Healthcare Workers’ Infant Feeding Hygiene Practices to Prevent Transmission of Respiratory Infectious Diseases, Including COVID-19: a Living Systematic Review. PROSPERO 2020; CRD42020184750.
    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) 2020-04-06
9/10 Yes A systematic review of indirect evidence finds uncertainty as to whether chest compression in patients with COVID-19 is aerosol generating or leads to infection transmission in cardiac arrest No Full review Other Couper K, Taylor-Phillips S, Grove A, Freeman K, Osokogu O, Court R, et al. COVID-19 in Cardiac Arrest and Infection Risk to Rescuers: A Systematic Review. Resuscitation 2020;151: 59-66.
    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 (row content last updated on 2020-08-07) 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 2020-05-01
8/11  No  Studies show mortality rates among ICU patients is correlated with invasive ventilation, renal failure and acute respiratory distress syndrome, although absolute values have been shown to vary between regions.  No Full review  Other  Chang R, Elhusseiny KM, Yeh Y, Sun W. COVID-19 ICU and mechanical ventilation patient characteristics and outcomes - A systematic review and meta-analysis. medRxiv 2020.
    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  2020-03-26
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. 
7/11  No  Risk stratification and triage for patients with comorbid COVID-19 and cardiovascular disease should use clinical history, physical examination, pulse oxymetry and other laboratory markers to recognize high-risk patients in a timely manner  No  Full review  Other  Momtazmanesh S, Shobeiri P, Hanaei S, Mahmoud-Elsayed H, Dalvi B, Malakan Rad E. Cardiovascular disease in COVID-19: a systematic review and meta-analysis of 10,898 patients and proposal of a triage risk stratification tool. Egypt Heart J. 2020;72(1):41. Published 2020 Jul 13. doi:10.1186/s43044-020-00075-z
    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. 
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 coronavirus infection
Yes (row content last updated on 2020-08-07) 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. 
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. 
      2020-06-08  8/10 No  No evidence was found on the effectiveness of cohorting COVID-19 positive residents to shared rooms in healthcare facilities No  Rapid review  Benefits and harms  Technical Advisory Committee, Health Agency of Canada. Rapid review: What is the effectiveness of cohorting virus-positive residents to shared rooms in care facilities? Hamilton, ON: National Collaborating Centre for Methods and Tools; 2020. 
    Death certification                
    Handling dead bodies                
  Service planning for the ongoing management of other conditions                
    Changing acute care surgery and trauma-care procedures  Not specified 4/9 No  Conservative treatment, use of disposable instruments and low CO2 insufflation pressuers are all recommended practices for reducing risk of COVID-19 infection among health workers when conducting urgent pediatric surgery for patients with COVID-19 No Full review Other Prato AP, Conforti A, Almstrom M, Van Gemert W, Scuderi MG, Khen-Dunlop N, et al. Management of COVID-19-positive pediatric patients undergoing minimially invasive surgical procedures: Systematic review and recommendations of the Board of the European Society of Pediatric Endoscopic Surgeons. Frontiers in Pediatrics. 2020;8:259.
    Changing cancer-treatment procedures                
    Delaying return visits, elective procedures, etc.              
  Infrastructure planning and resource allocation                
    Personal protective equipment under shortage conditions (including N95 respirators for health workers)  2020-04-11  6/9 No  In non-human, non-COVID-19 studies focused on influenza and bacterial infections, ultraviolet germicidal irradiation, moist heat, microwave generated steam, and hydrogen peroxide vapor were found to be effective at disinfecting and maintaining filtration efficiency in surgical and N95 masks No Full review Benefits and harms Seresirikachorn K, Phoophiboon V, Chobarporn T, Tiankanon K, Aeumjaturapat S, Chusakul S, et al. Decontamination and reuse of surgical masks and N95 filtering facepiece respirators during COVID-19 pandemic: A systematic review. Infecton control and hospital epidemiology. 2010:1-39.
      N/A (Protocol)
n/a No  [Protocol] A scoping review on decontamination and reuse of N95 and surgical facemasks is currently being conducted
Yes (row content last updated on 2020-10-08)
Protocol  Other  McNally JD, O'Hearn K, Choong K, Zorko DJ, Gertsman S, Agarwal A, et al. Live scoping review of N95 and surgical facemask decontamination and reuse. 2020 
      N/A (Protocol)
n/a No  [Protocol] A review on the effectiveness of sterilization techniques for N95 filtering facepiece respirators is currently being conducted
Yes (row content last updated on 2020-10-08)
Protocol  Benefits and harms  Rajaee A, Eshkevari PS, Lenhardt R,Stuart A, Ziegler C. Will Decontamination of N95 Filtering Facepiece Respirators Result in Compromised Performance? A Living Systematic Review. PROSPERO 2020; CRD42020179695.
    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 (row content last updated on 2020-08-07)  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 (row content last updated on 2020-08-07)  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. 
5/9  No  Studies from the pre-COVID era show that telehealth has been succesfully used to provide ongoing care for a number of urologic conditions, including prostate cancer and urinary infection No  Full review  Other  Novara G, Checcucci E, Crestani A, Abrate A, Esperto F, Pavan N, et al. Telehealth in urology: A systematic review of the literature. How much can telemedicine be useful during and after the COVID-19 pandemic? European Urology. 2020;S0302-2838(20)30454-1. 
4/9  No  Studies from the COVID-19 era and beyond suggest there is scarce evidence on the use of telemedicine for neurosurgical patients, although some results from resource-constrained settings show promise  No  Full review  Other  Eichberg DG, Basil GW, Di L, Shah AH, Luther EM, Lu VM. Telemedicine in neurosurgery: Lessons learned from a systematic review of the literature for the COVID-19 era and beyond. Neurosurgery. 2020;nyaa306. 
5/10 No Studies mainly from the pre-COVID era show that using telemedicine for otolaryngology produces adequate images for diagnosis, and has high acceptability among patients and providers No  Full review  Other  Ning AY, Cabrera CI, D'Anza B. Telemedicine in Otolaryngology: A Systematic Review of Image Quality, Diagnostic Concordance, and Patient and Provider Satisfaction [published online ahead of print, 2020 Jul 13]. Ann Otol Rhinol Laryngol. 2020;3489420939590. doi:10.1177/0003489420939590 
6/9 No  Studies with variable risk of bias suggest that telemedicine for orthopaedics consultations can be safe, cost-effective, and be used to accurately diagnose patients, while having good acceptability among both patients and providers No  Full review  Benefits and harms  Haider Z, Aweid B, Subramanian P, Iranpour F. Telemedicine in orthopaedics and its potential applications during COVID-19 and beyond: A systematic review. Journal of telemedicine and telecare. 2020;1357633X20938241. 
  Workforce planning (including workforce shortages management) and development                
    Role extensions                
    Training in new procedures 2020-03-19
8/10 No A systematic review of observational studies found that disaster-training programs for medical students seems to improve their knowledge, skills and pandemic preparedness. No evidence on clinical performance was identified No Full review Other Ashcroft J, Byrne MHV, Brennan PA, et al Preparing medical students for a pandemic: a systematic review of student disaster training programmes. Postgraduate Medical Journal Published Online First: 09 June 2020.
    Replacements when sick                
    Movement-control strategies                
    Supports to unpaid caregivers                
    Volunteer engagement                
    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                 

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