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Evidence about health-system arrangements

 

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 - no results yet available] 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 2020-12-07) 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 2020-05-20
7/10  No  Although very little evidence is available to understand the impact of COVID-19 on Indigenous communities, the importance of having culturally appropriate responses to address the impact of the pandemic on this population is increasingly clear Yes (row content last updated on 2021-01-18) Rapid review  Other  National Collaborating Centre for Methods and Tools. Rapid review: What is known about the impact of the COVID-19 pandemic on Indigenous communities in Canada? Hamilton: National Collaborating Centre for Methods and Tools.; 2020.
    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 2020-06-26
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 2021-01-18) 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 2020-07-09
4/10  No  Hospital surge capacity planning models differ in their planning horizon, age-stratification parameters, and patient care pathways No  Full review  Other  Klein MG, Cheng CJ, Lii E, Mao K, Mesbahi H, Zhu T, et al. COVID-19 models for hospital surge capacity planning: A systematic review. Disaster Medicine and Public Health Preparedness. 2020:1-17. 
    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. 
      2020-04-21
7/11  No  Initial results from attempts to develop a risk stratification and triage tool for patients with comorbid COVID-19 and cardiovascular disease indicate clinical history, physical examination, pulse oxymetry and other laboratory markers can help recognize high-risk patients in a timely manner, although validation of the tool in future studies is still needed 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  2020-04-02
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. 
      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. 
      2020-04-06 8/11  No  Using preprocedural mouth rinse using tempered clorhexidine appears to be the preferred method to reduce the aerosol-related bacterial load in dental practice  No  Full review  Other  Koletsi D, Belibasakis GN, Eliades T. Interventions to Reduce Aerosolized Microbes in Dental Practice: A Systematic Review with Network Meta-analysis of Randomized Controlled Trials [published online ahead of print, 2020 Jul 13]. J Dent Res. 2020;22034520943574. doi:10.1177/0022034520943574 
      2020-07-21
4/11  No  SARS-CoV-2 RNA is frequently found in the air near and around spaces used by COVID-19 patients in hospital settings such as bathrooms, but limited evidence has been found to determine the infectivity of this airborne viral material No  Full review  Other  Birgand G, Peiffer-Smadja N, Fournier S, Kerneis S, Lescure FX, Lucet JC. Airborne contamination of COVID-19 in hospitals: A scoping review of the current evidence. medRxiv. 2020 
      2020-05-27
6/10  No  The evidence available is insufficient to evaluate the effectiveness of aerosol boxes and barrier enclosures for airway management in COVID-19 patients No  Full review  Other  Sorbello M, Rosenblatt W, Hofmeyr R, Greif R, Urdaneta F. Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: A scoping review and narrative synthesis. British Journal of Anaesthesia. 2020. 
      2020-06-22
7/9  No  The limited number of low-quality studies available makes is difficult to determine which effective infection prevention and control practices can be used in inpatient psychiatric facilities  No  Rapid review  Other  National Collaborating Centre for Methods and Tools. What is known about best practices for infection prevention and control in inpatient psychiatric 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. 2020-07-01  6/9  No  Surgical practice was affected by hospital lockdown, but no evidence was found on the impact of these surgical practice changes on patient outcomes [Review of studies conducted during COVID-19, Ebola, MERS and SARS outbreaks] Yes (row content last updated on 2021-01-18) Rapid review Other Lee Y, Kirubarajan A, Patro N, Sam Soon M, Doumouras AG, Hong D. Impact of hospital lockdown secondary to COVID-19 and past pandemics on surgical practice: A living rapid systematic review. American Journal of Surgery. 2020;S0002-9610(20)30742-X.
  Infrastructure planning and resource allocation                
    Personal protective equipment under shortage conditions (including N95 respirators for health workers)   
 
   
 
    For reusing or decontaminating PPE, see public-health measures                 
    Ventilators for sick COVID-19 patients 2020-05-01  6/9 No  A number of decision-support tools exist to inform the allocation of ICU beds and ventilators during public-health emergencies including COVID-19 No  Full review  Other  Cardona M, Dobler C, Koreshe E, Heyland DK, Nguyen R, Sim JPY, et al. Scoping review supporting decision-making on allocation of ICU beds and ventilators in pandemics. medRxiv. 2020. 
    Medications and other technologies (under shortage conditions due to disrupted supply chains)                
    Remote monitoring 2020-05-31 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 2021-01-18) 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 2021-01-18) 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. 
      2020-04-08
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. 
      2020-04-05
4/9  No  The use of telemedicine might be feasible for use in neurosurgical patients, although some results from resource-constrained settings show promise [Review of studies conducted during the pre-COVID era and beyond] 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. 
      2020-05-01
6/9 No  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 [Review based on studies of variable quality] 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. 
      2020-04-20
7/9  No  Virtual care interventions appear most effective as a supplement to or facilitator of in-person trauma-focused care for psychological therapies to reduce the psychological symptoms associated with domestic violence or sexual assault [Review based on studies of unknown quality] No  Rapid review  Benefits and harms  Montesanti S, Silverstone P, Wells L, Ghidei W. Examining the use of virtual care interventions to provide trauma-focused treatment to domestic violence and sexual assault populations. Edmonton, AB: Canadian Institutes of Health Research; 2020. 
  Workforce planning (including workforce shortages management) and development                
    Recruitment                
    Role extensions                
    Training in new procedures 2020-03-19
8/10 No Disaster-training programs for medical students seems to improve their knowledge, skills and pandemic preparedness. No evidence on clinical performance was identified [Review of observational studies] 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.
      2020-05-18
5/9  No  Online learning in medical education can be facilitated by using video conferencing synchronolousy, and giving instructors enough tools to adapt existing teaching strategies that enable the creation of a supportive learning environment No  Rapid review  Other  Gordon M, Patricio M, Horne L, Muston A, Alston SR, Pammi M, et al. Developments in medical education in response to the COVID-19 pandemic: A rapid BEME systematic review: BEME Guide No. 63. Medical Teacher. 2020;1–14.  
      2020-05-02
5/9  No  A systematic review exploring management strategies and training for the medical-resident workforce during the COVID-19 pandemic found that residents need to be trained in infection prevention methods, and that training methods need to be adapted to alternative virtual teaching methods to maintain all pillars of residency education No  Full review  Other  Tolu LB, Feyissa GT, Ezeh A, Gudu W. Managing resident workforce and residency training during COVID-19 pandemic: Scoping review of adaptive approaches. Advances in Medical  Education and Practice. 2020;11:527-535. 
    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 2020-06-08  4/9  No  A review evaluating the evidence regarding the resumption of elective surgery only found modelling studies estimating the time needed to clear the backlog of deferred and cancelled procedures, and no assessments of the options available to efficiently resume these services were identified No  Rapid review  Other  Health, N., 2020. Resuming Elective Surgery. [ebook] NSW Government. Available at: <https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0003/594516/20200713-Evidence-Check-Resume_Elec-Surg.pdf> [Accessed 23 July 2020]. 
    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 2020-05-02
5/9  No  A systematic review exploring management strategies and training for the medical-resident workforce during the COVID-19 pandemic found that residency directors need to ease the impact of COVID-19 on the accreditation process by working with accreditation bodies and local clinical competency committees No  Full review  Other  Tolu LB, Feyissa GT, Ezeh A, Gudu W. Managing resident workforce and residency training during COVID-19 pandemic: Scoping review of adaptive approaches. Advances in Medical  Education and Practice. 2020;11:527-535. 
  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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