Table 2

Summary of included reviews organised according to the Cochrane EPOC taxonomy of delivery arrangement interventions

Delivery arrangement by EPOC taxonomy category and subcategoryEPOC definitionReviews (n) (Cochrane reviews, n)Primary studies (n) (RCTs)Empty reviews (n)Types of interventions (see online supplementary file 2 for details)
How and when care is delivered (n=47)
Queuing strategiesA reduction or increase in time to access a healthcare intervention, for example, managed waiting lists and managing ER wait time7 (2)112 (22)1
  •  ED visit reduction programmes.

  •  Improving patient flow and quality of care in the ED.

  •  Interventions to reduce waiting times for elective surgical procedures.

  •  Patient-initiated clinics for patients with chronic or recurrent conditions managed in secondary care.

Group versus individual careProviding care to groups versus individual patients5 (1)134 (124)0
  • Group clinics (chronic conditions and antenatal care).

Quality and safety systemsEssential standards for quality of healthcare and reduction of poor outcomes related to unsafe healthcare33 (11)774 (246)0
  •  Immediate versus deferred delivery of the preterm baby with suspected foetal compromise for improving outcomes.

  •  Implementation of guidelines and evidence-based care.

  •  Improving integrated care models in chronic diseases.

  •  Interventions to increase breastfeeding uptake.

  •  Medication reconciliation interventions at the hospital.

  •  Patient safety interventions.

  •  Promoting hand hygiene.

  •  Promoting use of guidelines and evidence-based medicine.

  •  Reducing disparities in health and healthcare.

  •  Reducing exposure to ionising radiation from medical imaging.

  •  Reducing medication overprescription (antibiotic use, opioid prescription, administration errors in children and adults, inappropriate prescribing in elderly).

  •  Using interpreters for non-English speakers on the delivery of palliative care (cancer).

TriageManagement of patients attending a healthcare facility or contacting a healthcare professional by phone, and receiving advice or being referral to an appropriate service2 (0)65 (2)0
  •  Improving patient flow and quality of care in the ED.

  •  Pharmacist involvement in care for patients with chronic disease.

Where care is provided and changes to the healthcare environment (n=55)
EnvironmentChanges to the physical or sensory healthcare environment, by adding or altering equipment or layout, providing music and art1 (1)1 (1)0
  •  Environmental interventions to increase breastfeeding uptake while mothers are in the hospital.

Outreach servicesVisits by health workers to different locations, for example, involving specialists, generalists and mobile units1 (1)2 (2)0
  •  Mobile clinics for women’s and children’s health.

Site of service deliveryChanges in where care is provided, for example, home versus healthcare facility, inpatient versus outpatient, specialised versus non-specialised facility, walk-in clinics, medical day hospital and mobile units51 (20)956 (320)1
  • Alternatives to hospitalisations: outpatient management, quick diagnostic units, hospital at home, observation units (for induction of labour, intravenous antibiotic therapy for cystic fibrosis, cardiac arrest, kidney dialysis, COPD, psychosis, paediatric care).

  • ED-based interventions (for managing alcohol misuse, domestic violence and palliative care).

  • Home visiting (for pregnancy, child health and maltreatment, social determinants of health and partner violence).

  • Home-based prevention and rehabilitation.

  • The patient-centred medical home.

  • Prehospital intervention for sepsis.

  • Reaching youth with out-of-facility services (HIV and reproductive health).

  • School-based health centres for mental health and social determinants of health.

  • Therapeutic communities for mental health.

  • Waiting room-based interventions to prevent STD.

Size of organisationsIncreasing or decreasing the size of health service provider units1 (1)5 (0)0
  • Centralisation, specialisation and increasing volume of services to promote quality (eg, cancer care and surgery).

Transportation servicesArrangements for transporting patients from one site to another1 (1)38 (0)0
  • Helicopter emergency medical services for adults with major trauma.

Who provides care and how the workforce is managed (n=80)
Role expansion or task shiftingExpanding tasks undertaken by a cadre of health workers or shifting tasks from one cadre to another, to include tasks not previously part of their scope of practice65 (12)1110 (586)1
  •  Advanced practice nursing in older people and in long-term care.

  •  Advanced trauma life support training for hospital health professional and ambulance crews.

  •  Carer involvement in cognition-based interventions for people with dementia.

  •  Community-based health worker interventions.

  •  Interventions to increase breast feeding.

  •  Nurse–physician substitution.

  •  Peer-led interventions (eg, in mental health).

  •  Pharmacist involvement in care for patients with chronic conditions.

  •  Primary care-led provision of care (eg, GPs working in ED).

  •  Radiographers in advanced roles.

Self-managementShifting or promoting the responsibility for healthcare or disease management to patients or their families15 (6)298 (216)0
  •  Patient navigation (breast cancer).

  •  Promoting self-management (in chronic diseases, specifically HIV, diabetes foot care, COPD, asthma, children with epilepsy, anxiety, MS, IBS; self-administration of medication in the hospital, oral anticoagulation and home uterine monitoring for detecting preterm labour).

  •  Reducing medication and overprescription (antibiotic use, opioid prescription, administration errors in children and adults, inappropriate prescribing in the elderly).

Coordination of care and management of care processes (n=122)
Integrated healthcare systemsConsolidating the provision of different healthcare services to one (or simply fewer) facilities16 (3)406 (258)0
  •  Integrated care models for various conditions.

Shared decision makingSharing healthcare decision-making responsibilities among different individuals, potentially including the patient14 (5)487 (393)0
  •  Educational interventions for patients and carers.

  •  Improving healthcare professionals skills (eg, communication in cancer, performance in nursing homes, recognition and management of deteriorating patients and genetic education).

  •  Promoting adoption of shared decision making.

  •  Reducing medication and overprescription.

  •  Shared decision making in pregnancy and delivery, treatment in older people and cancer screening.

Packages of careIntroduction, modification or removal of packages of services designed to be implemented together for a particular diagnosis/disease, for example, tuberculosis management guidelines and newborn care protocols1 (1)5 (5)0
  •  Care delivery models/disease management.

Case managementIntroduction, modification or removal of strategies to improve the coordination and continuity of delivery of services, that is, improving the management of one ’case’ (patient)14 (4)375 (260)0
  •  Advance care planning (eg, haemodialysis patients, palliative care and end-of-life interventions).

  •  Case management in chronic diseases, specifically CVD, type 2 diabetes, cancer, childhood obesity, haemophilia, mental health, multimorbidities and chronic viral hepatitis.

  •  Outpatient case management.

Disease managementProgrammes designed to manage or prevent a chronic condition using a systematic approach to care and potentially employing multiple ways of influencing patients, providers or the process of care16 (3)298 (169)1
  •  Adolescent-specific prenatal interventions on improving attendance and reducing harm during and after birth.

  •  Care delivery models/disease management.

  •  Chronic disease management—asthma.

  •  Improving healthcare professionals skills.

  •  Outpatient management of cardiometabolic risk factor control in people with diabetes.

Care pathwaysAim to link evidence to practice for specific health conditions and local arrangements for delivering care8 (2)99 (24)0
  •  Advanced care planning.

  •  Care delivery models/disease management.

  •  Critical care.

  •  Interventions to improve linkage with or retention in HIV services.

  •  Rapid response systems to reduce hospital mortality.

TeamsCreating and delivering care through a multidisciplinary team of healthcare workers22 (4)398 (229)1
  •  Multidisciplinary team care for dementia and other mental health conditions, older adults, epilepsy, asthma, HIV, hearth failure, chronic cough in children, antenatal care, chronic disease management, specifically CVD, type 2 diabetes, cancer, childhood obesity, haemophilia, multimorbidities and chronic viral hepatitis.

  •  Team interventions to promote work participation in people with regional musculoskeletal pain.

  •  Multidisciplinary team care in chronic disease.

  •  Multidisciplinary team in neonatal care.

Communication between providersSystems or strategies for improving the communication between healthcare providers6 (2)105 (44)0
  •  Improving clinical communication in hospitals, between primary and secondary care; improving patient handovers from hospital to primary care and vice versa.

Transition of careInterventions to improve transition from one care provider to another7 (0)138 (26)0
  •  Transition from paediatric to adult care settings or services.

Discharge planningAn individualised plan of discharge to facilitate the transfer of a patient from hospital to a postdischarge setting18 (4)243 (211)0
  •  Early supported discharge planning (acute stroke, COPD, older adults, children with cancer and febrile neutropaenia).

  •  Fast-track surgery programmes (liver surgery).

  •  Providing written information to reduce readmissions in heart failure.

  •  Transitional care management after hospital discharge to reduce 30-day readmission rates.

ICT systems (n=189)
Health information systemsHealth record and health management systems to store and manage patient health information, for example, electronic patient records, or systems for recalling patients for follow-up or prevention13 (4)718 (118)0
  • Health notes versus EMR in pregnancy.

  • Interventions to improve attendance of appointments.

  • Paediatric track and trigger systems for hospitalised children.

  • Patient safety interventions that use technology.

  • Recall intervals (for dental visits, women with history of gestational diabetes, TB appointments.

  • Reminder interventions to improve treatment adherence.

  • The use of medical scribes in healthcare settings.

The use of ICTTechnology-based methods to transfer healthcare information and support the delivery of care13 (1)627 (250)0
  • Computerised clinical decision support to enable patient-centred care (nutrition informatics and advice on drug dosage).

  • Medication organisation devices.

  • Medication reconciliation interventions in the hospital.

  • Multimedia educational interventions for consumers about prescribed and over‐the‐counter medications.

  • Patient portals.

  • IT interventions for reducing inappropriate imaging and testing (eg, cardiac, low-back pain imaging and lab tests ordering by GPs).

  • IT interventions for reducing medication use and overprescription.

  • Serious games for professional training and patient education (eg, chronic diseases and mental health).

Smart home technologiesElectronic assistive technologies1 (0)48 (9)0
  • Remote monitoring (eg, after recent hospital discharge with heart failure, in older adults, asthma).

TelehealthExchange of healthcare information from one site to another via electronic communication162 (29)3533 (2527)2
  • Self-care applications.

  • Social networks and social media.

  • Telecoaching (telephone counselling; peer support programmes; automated telephone messaging; web-based programmes, for example, cognitive–behavioural therapy for mental health conditions, coaching for chronic disease).

  • Telehealth (email communication, mobile phone messaging, mobile phone technology, mobile technology or range of intervention types).

  • Telemedicine (screening, telerehabilitation and telemonitoring).

Goal-focused reviews (n=38)
Interventions to address social determinants of health14 (2)319 (123)0
  • Culturally appropriate prevention and care (indigenous populations, racial–ethnic minorities, low socioeconomic populations).

  • Eliminating repeat unintended pregnancy in teenagers.

  • Improving access to healthcare for homeless people.

  • Interventions to address social determinants of health for minority populations (ethnic and racial disparities).

Improving medication adherence11 (2)654 (551)0
  • Interventions aimed at improving medication adherence (eg, chronic diseases, specifically diabetes, HIV and CVD in ethnic minorities).

Addressing multimorbidity in primary care1 (1)18 (18)0
  • Interventions addressing multimorbidity in primary care.

Preventing readmissions142 (42)0
  • Interventions for preventing unplanned 30-day hospital readmissions.

Reducing inappropriate imaging and testing324 (6)0
  • Interventions for reducing inappropriate imaging and testing.

Meeting family needs of the critically ill114 (1)0
  • Meeting family needs of critically ill patients in an ICU.

Communicating contraceptive effectiveness1 (1)7 (7)0
  • Communicating contraceptive effectiveness.

Improving adherence to treatment238 (35)0
  • Improving adherence to treatment in children with chronic diseases and adult heart transplant patients.

Interventions to increase retention in healthcare services1 (1)11 (9)0
  • Interventions to increase retention in mental health services.

Interventions to increase vaccine uptake3128 (77)0
  • Interventions to increase vaccine uptake in children and the elderly.

Total53112 230 (6911)7
  • COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; ED, emergency department; EMR, electronic medical record; EPOC, Effective Practice and Organisation of Care; ER, emergency room; GP, general practitioner; IBS, irritable bowel syndrome; ICT, information and communication technology; ICU, intensive care unit; IT, information technology; MS, multiple sclerosis; RCT, randomised controlled trial; STD, sexually transmitted disease; TB, tuberculosis.