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

Rumbidzai N Mutsekwa; Charlene Wright; Joshua M Byrnes; Russell Canavan; Rebecca L Angus; Alan Spencer; Katrina L Campbell

doi:10.1111/jep.13613

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

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

Authors

Rumbidzai N Mutsekwa^{1

2}, Charlene Wright^{2

3}, Joshua M Byrnes^{2

3}, Russell Canavan⁴, Rebecca L Angus^{1

5}, Alan Spencer¹, Katrina L Campbell^{2

3

6}

Affiliations

¹ Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.
² Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, Queensland, Australia.
³ Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.
⁴ Gastroenterology Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.
⁵ School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia.
⁶ Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.

PMID: 34405492
DOI: 10.1111/jep.13613

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.

Publication types

Systematic Review

MeSH terms

Australia
Delivery of Health Care*
Health Personnel*
Humans
Patient Care
Professional Role