Working together to prioritise and synthesise evidence about promising alternative models of healthcare delivery for a more sustainable health system
2Northern Health, Australia
3Bond University, Australia
4Flinders University, Australia
Healthcare expenditure is growing at an unsustainable rate in developed countries. A recent scoping review identified several alternative healthcare delivery models with the potential to improve health system sustainability.
Objectives: To (1) obtain input and consensus from an expert Delphi panel of policy, clinical, and consumer stakeholders about alternative models they considered most promising for increasing value in healthcare delivery in Australia, and (2) synthesise the evidence about the effects of three priority models.
Methods: The panel first reviewed a list of 84 models obtained through a preceding scoping review and contributed additional ideas in an open round. In a subsequent scoring round, the panel rated the priority of each model in terms of its potential to improve healthcare sustainability in Australia. Consensus was assumed when more than 50% of the panel rated a model as (1) very high or high priority or (2) not a priority or low priority.
Results: Eighty-two of 149 invited participants (55%) representing all Australian states/territories and wide expertise completed round one; 71 completed round two. Consensus on high priority was achieved for 59 alternative models; 14 were rated as (very) high priority by 70% of the panel. Top priorities included models for delivery and coordination of primary and/or secondary care for older adults living in aged care facilities, home versus hospital delivery of intravenous anti-cancer therapy for adults with cancer, and early discharge hospital at home versus in-hospital care for people with various conditions. These priorities have informed three new Cochrane reviews. No consensus was reached on 47 models, but no model was deemed low priority.
Conclusions: Input from an expert stakeholder panel identified healthcare delivery models not previously synthesised in systematic reviews that were a priority to investigate and led directly to new Cochrane reviews. Patient, public, and/or healthcare consumer involvement: Consumer advocacy organisation representatives contributed to the Delphi panel.