Evidence check
A rapid review outlining the available evidence on a discrete topic or question. Evidence includes grey and peer review literature. View all Evidence Checks by date of publication.
Asynchronous virtual care
Added: 5 Dec 2024
What are the types of asynchronous virtual care models and their implementation outcomes for patients, clinicians and health systems?
- Asynchronous virtual care refers to a virtual consultation or exchange of data between healthcare providers or between a healthcare provider and a patient that occurs non-simultaneously and with certain time delays between the transmission and response. The transmitted data can be either text (secure text messaging, email, questionnaire, health portal dialogue), image, video, sound or a mix of them. Synchronous (real-time), asynchronous and hybrid models can be the basis for patient visits and clinician-to-clinician consultations.
- Clinician-to-clinician asynchronous virtual care models are most commonly reported for interactions between primary care providers such as general practitioners and hospital specialists. Multiple reviews reported positive outcomes associated with asynchronous virtual consultations between clinicians, including improved hospital access to care, reduced referrals to hospital specialists, and improved or similar clinical outcomes to usual care in rural areas where access to specialist care is limited.
- Clinician-to-patient asynchronous virtual care was most commonly reported to be used in primary care and dermatology, followed by psychiatry. Devising and delivering a treatment plan was the most common activity reported, followed by other activities such as providing access login details, providing responses or feedback, referral and follow-up.
Umbilical cord blood therapy for cerebral palsy
Added: 5 Dec 2024
What is the evidence for the effectiveness and safety of using umbilical cord blood to treat cerebral palsy?
- What is the evidence for the effectiveness and safety of using umbilical cord blood to treat cerebral palsy?
- Internationally, no jurisdictions have approved stem cell therapies for cerebral palsy to date. Clinical trials have been mostly phase I or phase II trials, with a lack of phase III trials required for regulatory approvals.
Social licence for health data
Added: 5 Dec 2024
What are the international approaches to establishing social licence for the use of health data?
- Social licence, otherwise referred to as social licence to operate, refers to an approval or consensus from the society members or the community for the users, either as a public or private enterprise or individual, to use their health data as desired or accepted under certain conditions. Social licence is a dynamic and fluid concept and is subject to change over time often influenced by societal and contextual factors.
- Internationally, although not always explicitly referred to as a social licence, the most common approach to establishing public trust and support and identifying common grounds or agreements on acceptable practices for use of data is through public engagement. Engagement methods and mechanisms for gaining public perspectives vary across countries.
Rural renal dialysis models of care
Added: 5 Dec 2024
What is the evidence for renal dialysis models of care in rural and remote areas with regard to patient, caregiver and health system outcomes?
- In Australia and internationally, there is substantial evidence on the kidney health disparities and kidney replacement therapy access barriers experienced by rural populations. Despite this, there is limited evidence evaluating the outcomes of the dialysis model of care in rural and remote areas.
- Four main types of models of care in rural and remote Australia were identified, including: satellite dialysis units located within regional hospitals or remote locations, Aboriginal-controlled dialysis units, mobile dialysis truck, and self-care home dialysis.
Gender disparity and gender equality measures in health
Added: 21 Oct 2024
What are the most significant gender disparities in access to services and health outcomes? (including minority groups, gaps in knowledge and data)
What are the most effective strategies to advance gender equality with respect to access to services and health outcomes (including policies, programs and services)?
What are the system-level barriers and enablers of addressing gender equality with respect to healthcare access and health outcomes?
What are the system-level measures, barriers and enablers of addressing gender equality in the healthcare workforce?
How are gendered impacts and gender equality targets assessed in healthcare policies, programs and services in other jurisdictions?
What are the most effective strategies to advance gender equality with respect to access to services and health outcomes (including policies, programs and services)?
What are the system-level barriers and enablers of addressing gender equality with respect to healthcare access and health outcomes?
What are the system-level measures, barriers and enablers of addressing gender equality in the healthcare workforce?
How are gendered impacts and gender equality targets assessed in healthcare policies, programs and services in other jurisdictions?
- In literature, the terms relating to gender and sex such as woman and female or man and male are often used interchangeably. There is a lack of recognition of gender diversity which is inclusive of all genders such as non-binary and reporting of gender-specific data for those who identify as genders other than man or woman. While the original language relating to gender and sex was retained when citing information sources directly to avoid misinterpretation, the definitions of gender and sex, as specified above, were applied throughout when not directly citing the literature.
- In Australia and globally, women live longer than men yet spend fewer years in good health. The health disparity between women and men can be attributed to the differential effectiveness of interventions such as therapeutics due to biological differences between sexes. It can also be attributed to the lack of and bias in data and knowledge that result in systematic underestimation and underinvestment in diseases disproportionally and differently affecting sexes (biological construct) and genders (social construct).
- Disparity in care delivery and access can be influenced by gender as well as other intersecting factors such as culture, race, ethnicity, education, socioeconomic background and education.
Health in All Policies and similar approaches
Added: 14 Oct 2024
What is the evaluative evidence for Health in All Policies (HiAP), or similar approaches, internationally?
What frameworks exist, and what are the barriers and enablers for implementation, of HiAP or similar approaches?
What frameworks exist, and what are the barriers and enablers for implementation, of HiAP or similar approaches?
- HiAP refers to a collaborative and intersectoral approach to addressing social determinants of health and promoting health and equity that bring mutual benefit to all participating sectors. Similar approaches can refer to those that recognise and facilitate intersectoral or whole-of-government collaboration to promote physical and mental health and health equity.
- Evaluative evidence on HiAP suggests a benefit in improving immediate and intermediate intersectoral relationships and processes and bringing about a change in policymaking mindsets and culture that recognise social determinants of health. Long-term impact on health and equity is however difficult to measure and track over time and across multiple sectors and therefore remains uncertain due to gaps in evaluative evidence.
Hospital in the home evidence brief
Added: 18 Jun 2024
What is the evidence for length of stay and cost-effectiveness of the hospital in the home (HITH) models as compared to inpatient care for acute conditions?
- The definition and measurement of the length of stay in models involving HITH varies across studies, with some reporting on the length of stay while occupying a hospital bed while others reporting on the length of stay or treatment for both the hospital and HITH stays. Overall, the evidence suggests that HITH reduces the number of hospital bed days. However, the evidence on the total number of days patients receive care/treatment is mixed and some studies reported it increased with HITH compared to inpatient care only.
- The admission avoidance (step-up) model was associated with lower cost, lower mortality rates and comparable or lower readmissions to inpatient care.
- The early supported discharge (step-down) model was associated with comparable mortality, readmission and a shorter hospital length of stay to inpatient care. The findings on costs were mixed and likely due to differences in patient characteristics, interventions, cost components and cost measures, with some reporting reduced costs while others reporting increased overall costs.
Time-based targets for ED stays evidence brief
Added: 18 Jun 2024
What are the time-based targets for length of stay in emergency departments (ED) across major health systems and what is the impact of these targets on outcomes?
How do they compare to the new targets in NSW?
How do they compare to the new targets in NSW?
- In Australia and across major health systems, the time-based access targets for ED stays varied across jurisdictions.
- Literature on assessing the impact of time-based ED targets on patient, clinician and system outcomes comprises mainly observational studies with varying degrees of quality. Compared to pre-introduction, there is evidence to demonstrate the benefits of introducing targets in reducing mortality, ED crowding, time to assessment and admission. There is also evidence of some unintended consequences such as performance data manipulation or increased pressure on staff.
- Qualitative evidence suggested that ED clinicians perceived the time-based targets as having both positive and negative impacts on quality of care.
Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive, but aim to provide a balanced assessment of what is already known about a specific problem or issue. This brief has not been peer-reviewed and should not be a substitute for individual clinical judgement, nor is it an endorsed position of NSW Health. Evidence checks are archived a year after the date of publication.