Journal of Health Services Research & Policy最新文献

{"title":"What factors influence service integration and delivery by integrated neighbourhood teams operating across local health, care, and voluntary sector organisations? A rapid synthesis of qualitative evidence from the UK.","authors":"Hannah A Long, Peter Bower, Sonya Rafiq, Nicky Cullum","doi":"10.1177/13558196261437005","DOIUrl":"https://doi.org/10.1177/13558196261437005","url":null,"abstract":"<p><p>ObjectivesIntegrated neighbourhood teams (INTs) are central to health system reforms in England, aiming to deliver local, coordinated, and personalised care. Understanding the factors that influence their successful functioning is crucial for informing local policy and practice. This rapid evidence synthesis aimed to answer the research question: What factors influence service integration and delivery by INTs operating across health, care, and voluntary sector organisations?MethodsIn February 2025, we searched Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant UK-based primary research and international evidence syntheses published within the last 10 years. The database searches were complemented by searches in Google Scholar and the Google search engine. Eligible studies reported evidence on factors shaping the successful functioning of local and neighbourhood-level integrated teams. Data were rapidly synthesised qualitatively.ResultsDatabase searches identified 5139 articles (4954 after duplicates were removed). Of these, 26 were eligible for inclusion, comprising nine primary studies and 17 evidence syntheses published between 2015 and 2025. The findings were highly consistent. Key factors supporting INT functioning included a clear, shared vision; effective leadership; strong working relationships based on trust and mutual respect; clarity on interprofessional roles and responsibilities; appropriate and sustained resources and funding; opportunities for staff learning and development; co-location, dedicated time for multidisciplinary team meetings; and interoperable information technology systems to support data sharing.ConclusionsThere is strong agreement on key relational and organisational factors that support INT functioning. Our practical framework can be used to support policymakers, commissioners, and professionals when planning and implementing INTs.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261437005"},"PeriodicalIF":2.7,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the quality of residential care for people with disabilities - What is the experience of inspectors when implementing care quality regulations in Ireland?","authors":"Paul Dunbar, Laura Keyes, John P Browne","doi":"10.1177/13558196261437759","DOIUrl":"https://doi.org/10.1177/13558196261437759","url":null,"abstract":"<p><p>BackgroundRegulation by an independent state authority is a common means by which governments seek to safeguard service users and ensure good quality health and social care services. Inspectors play a key role in this process as they work at the interface between regulator and regulatee. Our aim was to investigate the role played by inspectors in the implementation of care regulations in residential disability services in Ireland.MethodsWe conducted focus groups with inspectors of residential disability services in Ireland. Participant recruitment was facilitated with the permission of the regulator. Twenty-two people participated over five online focus groups. Thematic analysis was carried out on the interview data.ResultsFour parent themes were identified: overall views on the regulatory system; the importance of skill and strategy for the role of inspector; impediments to effective regulation and inspection; and, positive effects of regulation. While not directly responsible for implementing regulations in services, inspectors played a role by calling attention to poor practices, apportioning accountability at the appropriate level in regulated organisations, and behaving in a consultant-like fashion in support of managers. There were barriers that complicated and inhibited their work such as resource constraints and bureaucracy. Their observation of improvements in service quality led them to conclude that regulation was an effective intervention, despite some flaws.ConclusionInspectors had a clear sense of the part they played in terms of aiding the implementation effort in services. They shared the goals of managers: trying to improve the quality of services and the lives of those that use services. While there were barriers that impacted on the effectiveness of their work, most inspectors regarded regulation as a positive intervention and had first-hand experience of its impact.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261437759"},"PeriodicalIF":2.7,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147529740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared clinical governance arrangements between NHS and independent acute hospitals in England: Findings from a national survey of senior leaders.","authors":"Gemma Stringer, Jane Ferguson, Kieran Walshe, Christos Grigoroglou, Thomas Allen, Michael Anderson, Karen Bloor, Eleanor Gee, Nils Gutacker","doi":"10.1177/13558196261431315","DOIUrl":"https://doi.org/10.1177/13558196261431315","url":null,"abstract":"<p><p>ObjectivesTo present the findings from a national survey of senior leaders in NHS and independent hospitals in England concerning the effectiveness of shared arrangements for clinical governance. To provide a comprehensive overview of shared arrangements for the oversight of consultants' practice, processes for appraisal and revalidation, and the management of significant concerns. The results from this study will improve understanding of the practical functioning of clinical governance processes at the interface between the NHS and the independent sector.MethodsBetween December 2023 and April 2024, an online survey was distributed to senior leads with governance responsibilities in NHS and independent hospitals in England.Results320 responses were received (response rate 42%), 235 from individuals working in NHS trusts (response rate 40%) and 85 from individuals in independent hospitals (response rate 48%). Respondents reported that some clinical governance arrangements are established across both sectors, with some relationships characterised as positive and relatively strong. However, relationships often depended on goodwill, personal connections, and consultant probity, rather than the systematic implementation of recommended processes. Respondents expressed concerns regarding the non-mandatory and unregulated nature of processes for sharing concerns, believing this led to insufficient resources and challenges in verifying information. They called for improved data quality, better communication and information sharing and more robust and formalised processes.ConclusionsShared clinical governance arrangements between the NHS and independent sectors are in place in some but not all of the organisations where respondents' consultants worked. This raises concerns about progress towards implementing the Paterson inquiry recommendations, including access to consultants' whole practice information and sharing concerns about consultants working across different providers. The findings may also hold relevance for international audiences where medical staff work across multiple healthcare providers. Further empirical research is needed to compare clinical governance arrangements between the NHS and independent sectors, and suggest how shared clinical governance can be organised to assure the quality and safety of care.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261431315"},"PeriodicalIF":2.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the resilience of a key health service: The response of acute surgical provision in England to the disruption of the COVID-19 pandemic.","authors":"Andrew Hutchings, Orlagh Carroll, Geoff Bellingan, David Cromwell, S Ramani Moonesinghe, Susan J Moug, Neil Smart, Ravinder Vohra, Robert J Hinchliffe, Richard Grieve","doi":"10.1177/13558196261426970","DOIUrl":"https://doi.org/10.1177/13558196261426970","url":null,"abstract":"<p><p>ObjectiveInternational health systems had the opportunity to assess the resilience of core health services to severe disruption following the onset of the COVID-19 pandemic. This paper examines the resilience of a core health service to shocks from COVID-19. We compare outcomes following emergency admissions in England during the second (Winter 2020/21) and third (Winter 2021/22) major waves of COVID-19 with the first wave and historic admissions from 2016 to 2019.MethodsThis cohort study included adult emergency admissions for five common acute surgical conditions: appendicitis, symptomatic gallstone disease, intestinal obstruction, symptomatic diverticular disease, and abdominal wall hernia in 122 acute hospital Trusts in England. Participants were 647,367 admissions in the hospital episode statistics (HES) inpatient database including 34,560 in the second wave and 36,628 in the third wave. Outcome was all-cause mortality at 90 days.ResultsThere were 1308 deaths in wave two (3.8% of admissions) and 1235 (3.4%) in wave three compared with 3431 (3.4%) in the historic cohort and 577 (4.7%) in wave one. Compared with pre-COVID admissions, we found weak evidence of increased mortality in the second wave. There was no evidence of increased mortality in the third wave, compared to historic cohorts the case-mix adjusted odds ratios were: appendicitis 0.96 (95% CI 0.49-1.87); gallstone disease 1.27 (95% CI 0.94-1.72); diverticular disease 1.04 (95% CI 0.79-1.36); hernia 1.06 (95% CI 0.76-1.47); and intestinal obstruction 1.02 (95% CI 0.87-1.19).ConclusionsBy the end of wave three, outcomes for emergency admissions with five common acute conditions had returned to pre-pandemic levels. Lessons learnt during the disruption of the first wave of COVID-19 helped the NHS in England adapt emergency surgical services during subsequent waves. These findings emphasise the importance of maintaining, or quickly restoring core service capacity to help patient outcomes return to pre-pandemic levels.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261426970"},"PeriodicalIF":2.7,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protected appointment-based waiting list strategies are associated with waiting time reductions in outpatient and community health services: A systematic review and meta-analysis.","authors":"Kate E Noeske, Nicholas F Taylor, Annie K Lewis, Katherine E Harding","doi":"10.1177/13558196261428359","DOIUrl":"https://doi.org/10.1177/13558196261428359","url":null,"abstract":"<p><p>ObjectivesMany different approaches are used to manage demand and reduce waiting lists in outpatient and community health settings. This systematic review aimed to synthesise evidence for models of care which are based on the principle of protecting capacity for new patients.MethodsWe conducted a systematic search of Medline (Ovid), Embase, PyscINFO and CINAHL from inception until April 2024. Eligible studies included use of a protected appointment model in an outpatient and community health service and compared data on measures of waiting. Two reviewers independently extracted data and assessed risk of bias. Methodological quality was assessed using the Downs and Black checklist. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used to evaluate evidence certainty for meta-analyses.ResultsA total of 26 studies were included in the review. Most studies described a specific, named model incorporating protected appointments, such as Open Access (n = 7), Advanced Access (n = 6), the Specific Timely Assessment and Triage Model (n = 6), and the Choice and Partnership Approach (n = 4). A single stepped wedge randomised controlled trial (n = 3,113) provided moderate certainty evidence of a large reduction in time from referral to first appointment (IRR -0.66, 95% CI -0.85 to -0.52), with a median reduction of 34%. Eight non-randomised studies of intervention (n = 43,655) provided moderate certainty evidence of a moderate to large reduction in waiting time (SMD = -0.66, 95% CI -0.95 to -0.36) with a weighted mean reduction of 81%. Studies that could not be included in the meta-analyses supported these findings. Five studies measured waiting list size and all reported reductions ranging from 44% to 98%. Other findings associated with interventions included increased service productivity and improved patient satisfaction.ConclusionsWaiting list reduction strategies incorporating protected appointments are associated with moderate to large reductions in waiting time in outpatient and community health services.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261428359"},"PeriodicalIF":2.7,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147276346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double-checking in the safe administration of medicines: Policy and practice in English hospitals.","authors":"Daisy Halligan, Hana Shamsan, Francesca Wilson, Robbie Foy, David Phillip Alldred, Rebecca Lawton","doi":"10.1177/13558196261421472","DOIUrl":"https://doi.org/10.1177/13558196261421472","url":null,"abstract":"<p><p>ObjectivesDouble-checking medication administrations is one of the most frequently used strategies to prevent errors and associated harm. This practice is time-consuming, introduces repeated interruptions into the care process and lacks evidence of effectiveness. Double-checking is widespread in hospitals worldwide. In England, double-checking happens despite there being no regulatory requirement except for intravenous drugs and medicines that require complex calculations. Many hospital Trusts have assimilated double-checking over the past 25-30 years in response to recommendations from the investigation of medication administration errors. There is currently no national picture in England of the extent to which organisational policies stipulate double-checking, the variation in double-checking policy or how closely double-checking is perceived to be conducted in accordance with policies. This study set out to address these gaps in our understanding.MethodsAn online survey was distributed to a network of Medication Safety Officers (MSOs) and Freedom of Information requests were sent to 118 English NHS acute hospital Trusts for policies underpinning medicines administration. Data were analysed to address the research questions.ResultsPolicies were received from 94 acute NHS Trusts (80% response rate) and 48 MSOs submitted a survey response (39% response rate). Double-checking policies vary considerably between Trusts. MSOs perceived that it is common in practice for double-checking not to be conducted in accordance with policy. All reviewed Trust policies required double-checking for controlled drugs. Further to this, many required double-checking for specific medicines or in particular circumstances. Most commonly, these were intravenous medicines, medicines administered to children, medicines requiring complex calculations and cytotoxic or chemotherapeutic medicines. However, policies varied considerably around administration of injectable medicines and insulin to adults. A minority of policies specified that 'intravenous fluids' needed to be double-checked. Most policies neither emphasised nor explained the importance of the independent nature of double-checking. There was also a great deal of variation between Trust policies in the medicines exempt from double-checking requirements.ConclusionsThe variation between policies identified by the present study might reflect a lack of robust evidence underpinning the practice of double-checking. Research is needed to understand if double-checking is effective at preventing medication errors and, if it is, the exact circumstances in which it is effective, to facilitate the standardisation of double-checking policies. Identifying circumstances in which double-checking is ineffective may justify the removal of some existing policies and could reduce nurse workload to free up time for patient-focused care.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261421472"},"PeriodicalIF":2.7,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staff experiences of implementing patient-initiated follow-up (PIFU) in the NHS in England: findings from a rapid qualitative evaluation.","authors":"Cyril Lobont, Rachel Hutchings, Stuti Bagri, Nadia Crellin, Theo Georghiou, Stephanie Kumpunen, Jenny Negus, Pei Li Ng, Camille Oung, Angus I G Ramsay, Sarah Reed, Chris Sherlaw-Johnson","doi":"10.1177/13558196261421165","DOIUrl":"10.1177/13558196261421165","url":null,"abstract":"<p><p><i>Objectives</i>The NHS in England has introduced various innovations to keep up with the growing demand for elective care, one of which is patient-initiated follow-up (PIFU). This evaluation sought to understand staff experiences of implementing PIFU.<i>Methods</i>We conducted a rapid qualitative service evaluation between June 2022 and July 2023, based on semi-structured interviews (n = 36) with operational/managerial and clinical NHS staff from five English NHS Trusts, and an online workshop with 21 additional members of staff from the English NHS. We drew on the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework to structure qualitative data collection and analysis and to generate new insights into the adoption of the innovation of PIFU.<i>Results</i>We found that implementation of PIFU affected staff roles, workload, and job satisfaction. Levels of PIFU uptake, and experience with similar models, affected the extent to which participants experienced the impact of PIFU. How PIFU was implemented varied. Some staff saw changes in their role because of new administrative demands, safety-netting procedures (such as proactive measures by specialty teams to mitigate the risk of patients not initiating appointments when necessary), and selection of suitable patients. PIFU was felt by some staff to increase, and by others to decrease, workload. PIFU affected intensity of work, interrelated with other factors such as the size of waiting lists, and conditions experienced by patients. Whether staff were satisfied with PIFU related to its impact on their role and workload. Satisfaction was also affected by whether staff believed PIFU delivered benefits for patients, and by the aims they felt were driving rollout.<i>Conclusion</i>PIFU can significantly affect the experiences of staff and change staff roles and workload. However, the impact of PIFU is not uniform. Staff perspectives on PIFU from all parts of the health system should be better understood and considered during pathway design.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261421165"},"PeriodicalIF":2.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiential learning from rapid evaluation in health and care.","authors":"Sonja Marjanovic, Sara Shaw","doi":"10.1177/13558196251391585","DOIUrl":"10.1177/13558196251391585","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"1-3"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of family caregivers in critical illness survivor recovery at home: A qualitative study.","authors":"A Fuchsia Howard, Kelsey Lynch, Sally Thorne, Sybil Hoiss, Rakesh C Arora, Omar Ahmad, Mary T Kelly, Sarah Crowe, Allana LeBlanc, Leanne M Currie, Robert C McDermid, Richard Doll, Anita David, Brianna Hou, Alice Erchov, Gregory Haljan","doi":"10.1177/13558196251382500","DOIUrl":"10.1177/13558196251382500","url":null,"abstract":"<p><p>BackgroundWhen critical illness survivors are discharged home, they encounter a myriad of physical, emotional, cognitive, and socioeconomic challenges which can endure for an extended period of recovery. Given the extent of patient need, family members often assume the role of informal caregivers. The work inherent in this role can significantly compromise their own health, which can, in turn, influence the nature and trajectory of recovery for the survivor.PurposeThis study aimed to describe the role of informal family caregivers in patient recovery from critical illness following hospitalisation, in the context of publicly-funded healthcare and where there were no critical care follow-up or aftercare programmes.MethodsGuided by a qualitative, interpretive description approach, in-depth semi-structured interviews were conducted with 25 family caregivers of patients recovering from critical illness at home. In total, 29 interviews were conducted: 21 caregivers were interviewed once, and 4 caregivers were interviewed twice. Interview data were analyzed thematically using inductive, constant comparative methods.ResultsThe nature of family caregiving was grounded in the patient's condition, whether it involved slow recovery vs stagnation or decline, and the caregiver's capacity to engage in care. Caregivers influenced patient recovery by (1) assuming daily living and physical care responsibilities; (2) providing motivational and emotional support; (3) searching for and gathering information; (4) monitoring and supervising health and treatment; and (5) managing medical appointments and advocating for resources.ConclusionsFamily caregivers fulfilled a central role in managing a wide range of needs of survivors, found to be pivotal for their recovery. Policy and practical support are needed to help caregivers fulfil this role alongside meeting their own personal challenges and responsibilities.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"31 1","pages":"34-45"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating patient characteristics and trends of avoidable emergency department visits: Informing community health services to reduce emergency department utilization.","authors":"Ryan P Strum, Andrew P Costa, Brent McLeod, Ravi Sivakumaran, Shawn Mondoux","doi":"10.1177/13558196251358761","DOIUrl":"10.1177/13558196251358761","url":null,"abstract":"<p><p>BackgroundThere is a growing debate on whether avoidable emergency department (ED) visits, those involving health issues that could have been managed in community settings, represent a significant workload for the department. Until recently an ED physician-validated measure of avoidable visits has not been available, hindering our understanding of these patients, services rendered in the ED and the nature of their conditions. We examined patient characteristics of ED visits retrospectively classified as avoidable and potentially avoidable at a Canadian academic hospital.MethodsWe conducted a retrospective cohort study using administrative ED data from an academic hospital in Hamilton, Canada from April 1, 2018 to August 31, 2023. We categorized all ED visits as avoidable, potentially avoidable, and not avoidable using the Emergency Department Avoidability Classification (EDAC). For each class, we analyzed patient characteristics and the top five physician interventions and diagnoses. We applied linear regression, locally weighted scatterplot smoothing (LOWESS) regression, and statistical process methods to examine monthly trends in avoidable and potentially avoidable visits. Additionally, we reported annual totals and length of stay for patients transported to the ED by paramedics.ResultsOverall, 58,528 (29.0%) of 201,741 ED visits were classified as either avoidable (11,302; 5.6%) or potentially avoidable (47,226; 23.4%). These patients were predominantly young-to-middle aged, with average visit durations of 3 hours 33 minutes (avoidable) and 4 hours 26 minutes (potentially avoidable). Their primary interventions were predominantly diagnostic imaging, skin repairs and mental health assessments. The proportion of ED visits in the study period that were avoidable increased from 2.1% to 7.7% and potentially avoidable from 18.2% to 21.2%. Approximately one-in-five paramedic transported patients were classified as having either an avoidable or potentially avoidable ED visit. Transported patients had an average length of stay of 4 hours 22 minutes for avoidable visits and 4 hours 35 minutes for potentially avoidable visits.ConclusionsA notable rise in the proportion of ED visits that could have been managed in non-ED settings was observed. Providing community clinicians with resources and capacity to manage and refer patients for diagnostic imaging, skin repairs and mental health assessments may reduce avoidable ED attendance. Further exploration of avoidable ED visits transported by paramedics could support refining ED diversion care models. Hospitals and health service policymakers could benefit from similar analyses using validated measures to identify care gaps that inform the development of new health services and models tailored to the specific needs of their communities.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"5-13"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}