Health care service interventions to improve the health care outcomes of hospitalised patients with extreme obesity: An evidence and gap map.

Abstract

ObjectivesWe set out to produce an evidence and gap map (EGM) on health care service interventions to improve health care outcomes for hospitalised patients with extreme obesity. Hospitalised patients with extreme obesity have poorer health care outcomes compared to normal weight patients. We also considered how hospital services can be coordinated and delivered to meet the care needs of patients with extreme obesity.MethodsA standardised five-stage EGM method was used to develop an intervention-outcome framework; identify current evidence; critically appraise the quality of evidence, extract, code, and summarise data in relation to the EGM objectives; and create a visualisation map to present findings. EPPI Reviewer Web software was used to generate an interactive EGM. The intervention-outcome framework was developed from internationally recognised health system performance and quality standards. This framework consisted of nine intervention (specialist workforce, special care pathways, assessment tools, equipment, moving and handling, specialist care areas, education, care bundles/packages, patient mobility) and six outcome categories (safety, effectiveness, efficiency, timely access, patient experience, health equity). Inclusion criteria were systematic reviews and primary studies that reported on health service interventions aimed to improve health care outcomes for patients with extreme obesity in the inpatient setting. Thirteen electronic databases were searched to identify studies for eligibility. The original searches were completed between November 2021 and March 2022. A repeat search was completed in August 2023.ResultsOf the 64,574 studies retrieved, 247 met eligibility criteria. Most of the excluded studies specifically related to bariatric weight loss surgical procedures or interventional techniques which could not be more broadly generalised to health care service provision. Of the 247 studies included, most studies (210; 85%) involved special care pathway interventions that related to specific points on a patient's health care journey such as peri-operative care, surgical recovery pathways, and airway support and pain management. Few studies focused on interventions related to a holistic patient-centred approach to care for patients with extreme obesity. Limited evidence existed on specific interventions that focused on safe moving and handling (26; 12.4%) and patient mobility (5; 2%). The most frequently measured outcomes were patient deterioration (193; 78%), patient injury (145; 59%) and medication safety (84; 34%).ConclusionsCurrent evidence predominantly focuses on isolated bariatric surgery patients rather than system-wide care delivery with a lack of evidence on addressing health care inequities between patients with extreme obesity and those of normal weight. This EGM provides an interactive resource to guide policymakers and service commissioners in developing comprehensive hospital services and to support clinicians in implementing coordinated care pathways. Researchers can use this EGM to identify and address gaps in evidence for integrated care approaches. Urgent research is needed to develop evidence-based frameworks for safe, dignified care delivery in the inpatient setting. This will ensure health care systems can effectively support patients with extreme obesity beyond specialised bariatric settings.