1 Establishing the evidence base for 'multiple site single service' (MSSS) models of care. (3rd November 2019) - Day, Matthew
Abstract : Background: In England plans for service reconfiguration increasingly include options for clinical services which are delivered across more than one clinical site, often in differing geographical locations or towns. The rationale for such models include the difficult and often conflicting balance between exacerbating inequalities in access to clinical services for patients whilst at the same time trying to improve quality and outcomes through consolidation. Aim: The East Midlands Clinical Senate in partnership with Public Health England (PHE) established a proactive workstream to review the clinical evidence for 'multiple site, single service models of care' (MSSS) to support clinical senates, commissioners and providers of services better assess the evidence base for these types of models of care. Methods: Systematic review (SR) undertaken. Framework developed to Support Clinical Senates through qualitative data collection and consultation with national and local clinical senate meetings to consider the experience of MSSS models and where they have worked successfully to improve outcomes. Results: SR identified 18 papers for inclusion. Evidence on this topic was largely service-specific and heterogeneous in study design and outcomes. We found evidence of 10 key enablers and barriers to implementation of MSSS models. There was no universal definition for MSSS models in the literature, but shared characteristics were identified which enabled the development of a descriptive framework. Mortality was the most frequently reported outcome and no study reported increased mortality as a result of service change. 4 studies reported on patient experience related to service change, with some evidence of improvement in patient satisfaction with care delivered via a MSSS model Conclusion: Using the systematic review findings and the qualitative feedback, a clinical outcomes based framework has been developed to utilise when reviewing these types of models of care.