Many publicly funded health systems use a mix of privately and publicly operated providers of care to deliver elective surgical services. The aim of this systematic review was to assess the role of privately operated but publicly funded provision of surgical services for adult patients who had cataract or orthopedic surgery within publicly funded health systems in high-income countries.

Electronic databases (Ovid MEDLINE, OVID Embase, and EBSCO EconLit) were searched on 26 March 2021, and gray literature sources were searched on 6 April 2021. Two reviewers independently applied inclusion and exclusion criteria to identify studies, and extracted data. The outcomes evaluated include accessibility, acceptability, safety, clinical effectiveness, efficiency, and cost/cost-effectiveness.

Twenty-nine primary studies met the inclusion criteria and were synthesized narratively. We found mixed results across each of our reported outcomes. Wait times were shorter for patients treated in private facilities. There was evidence that some private facilities cherry-pick or cream-skim by selecting less complex patients, which increases the postoperative length of stay and costs for public facilities, restricts access to private facilities for certain groups of patients, and increases inequality within the health system. Seven studies found improved safety outcomes in private facilities, noting that private patients had a lower preoperative risk of complications. Only two studies reported cost and cost-effectiveness outcomes. One costing study concluded that private facilities’ costs were lower than those of public facilities, and a cost–utility study showed that private contracting to reduce public waiting times for joint replacement was cost-effective.

Limited evidence exists that private-sector contracts address existing healthcare delivery problems. Value for money also remains to be evaluated properly.

Despite widespread use of oxygen (O2) therapy, there is relatively little available information on routine O2 administration and monitoring; this is an issue particularly when considering the potential risks associated with inappropriate O2 utilization. A rapid health technology assessment (HTA) was conducted to inform the Respiratory Health Strategic Clinical Network Oxygen Summit in Alberta on aspects related to current practice in the use of O2 therapy in acute care, including administration, safety and quality, and inappropriate practice. Clinical audit is a tool used to determine deviations in practice and to identify opportunities for improvement. The objective of this presentation is to describe the experience and lessons learned from including clinical audit studies in the rapid HTA.

A standardized rapid review approach was used to identify, select, and synthesize evidence from studies published in English from 2005 to 2016. A supplementary literature search conducted in 2018 provided additional background information on the value, applicability, and limitation of using results from clinical audit studies to inform questions of good practice.

Twenty-four clinical audit studies on O2 therapy were identified; the majority were conducted in the United Kingdom. The studies varied in design, methodology, and data and outcomes reporting. Ten studies investigated the appropriateness of O2 therapy prescription pre- and post-implementation of local initiatives and interventions, which helped pinpoint major gaps in current practice, and identified general recommendations for improvement of practice. A list of reporting criteria is proposed for improving the reporting of clinical audit studies results.

Conducting clinical audit studies is resource-intensive. In the absence of other research evidence and local practice data, translating results from clinical audit studies conducted in other jurisdictions, while challenging, can help address appropriateness questions. However, inferences from these studies may be suitable only for certain topics or an operating context.

Conventional wisdom suggests that accelerating the speed of cancer diagnosis should improve health outcomes. However, cancer diagnosis requires complex coordination and effective communication between care providers working across many areas of the healthcare system. Since 2000, several nations and jurisdictions have aimed to improve timeliness of cancer diagnosis by integrating and coordinating cancer diagnostic services for patients. The objective of this study was to describe the impact of these existing initiatives.

We conducted an environmental scan consisting of a literature review (published academic and grey literature) and key informant consultations (online surveys and telephone interviews with experts who have knowledge of existing initiatives). We searched for initiatives in the United Kingdom, the Nordic countries, Canada, Australia, and New Zealand. For each initiative, we extracted data on their development and implementation, structure and functioning, intended outcomes and effectiveness, costs and cost savings, and enablers and barriers.

Eighty-nine relevant documents and 20 key informants contributed to this study. We identified 21 relevant initiatives, including seven national initiatives targeting multiple types of cancer. The literature review found that most initiatives accelerated the diagnostic phase of cancer care by several days or weeks. These wait time reductions were often associated with improved patient experience, but not less advanced cancer stage or increased long-term survival. Insights from key informants improved our understanding of the costs, enablers, and barriers associated with program implementation and maintenance.

These results can be used as a first step to inform the development, evaluation, and improvement of international cancer diagnostic pathways. Stakeholders wishing to accelerate cancer diagnosis should consider the feasibility of achieving their intended program outcomes based on the existing research evidence, desired type of initiative, and jurisdiction's unique contextual factors.

Economic evaluations are a growing field of interest in the rehabilitation area. Research has questioned the quality of reporting of health economic evaluations. Poor reporting hinders the ability to provide accurate information for health care decision making. Therefore, the objectives of this study are to document on overall reporting quality of the published literature for rehabilitation economic evaluations; to identify if reporting quality has improved in health economic evaluations within the field of rehabilitation therapy since the publication of the Consolidated Health Economic Evaluation Reporting Standards (CHEERS); and to identify factors that could influence the reporting trends.

We searched databases for economical evaluations performed in the rehabilitation area published between 2013 and 2018. Study selection was performed by two independent reviewers using Covidence software. Data extraction was conducted by one reviewer using Microsoft Excel and independently verified by another reviewer. The quality of reporting was evaluated independently by two reviewers using the CHEERS checklist.

The search of the literature resulted in a total of 2195 published articles. Of these, 117 were considered to be potentially relevant. Independent review of these 117 articles led to the inclusion of 88 articles. This study is ongoing and complete results will be presented at the conference. Fifty papers have been analyzed in full. In general, the quality of reporting of the economical evaluations in the rehabilitation field was poor. The total mean and median for the CHEERS checklist was 17 points (out of 25) (range 8-24). Most of the analyzed studies did not report important methodological features of the economical evaluation as evaluated by the CHEERS checklist.

The quality of reporting of economic evaluations in the rehabilitation field is poor and inconsistent. Commonly the methods of the analyzed studies are under reported, thereby creating challenges in determining whether the information presented is sound.

A high-level, rapid review (1) was conducted on oxygen therapy issues studied in the past 10 years in acute care settings. The main objective was to determine the appropriateness/inappropriateness of use, safety issues, and quality of care associated with oxygen prescription, administration, and monitoring. The results from this review were used to inform an upcoming provincial oxygen summit.

The Health Technology Assessment review (1) used a standardized rapid review approach: a comprehensive search of literature (published in English from 2005 to 2016), study selection using a priori developed criteria, and a qualitative synthesis of the results. Iterative interactions with the requester were necessary to clarify and refine the research questions, scope, and inclusion criteria.

Twenty-four audit studies were reviewed, the majority published after 2011, in the United Kingdom, and also in single institutions. Twelve studies reported effects after implementing interventions for improvement of oxygen prescription. Many studies had caveats on design, data reporting, and outcomes, or they lacked an explanation of the methods of analysis. Studies conducted in rural settings, and on infants and children were unavailable. The reported issues with oxygen therapy included: a lack or an inconsistency of compliance with guidelines, local policies, and standards; inappropriate prescription and administration; variability in practice among healthcare providers; and suboptimal monitoring, including poor standards of medical chart documentation for patients receiving oxygen therapy, such as incomplete details on flow rate and oxygen concentration.

Possibly due to the general tendency to publish research findings that have statistically significant results, relatively few publications were found in the literature search. The universal use of oxygen therapy and the enrolment of consecutive patients in some of the studies increase the applicability of the findings to other institutions. The rapid review provided a timely synthesis of the available, credible research for use by local stakeholders for further discussions and planning.

Thorough documentation and clear reporting are essential when conducting a comprehensive literature search for a health technology assessment (HTA) or systematic review. The ultimate goal of this process is transparency and reproducibility with the added benefit of increasing the reader's confidence in the research. Thorough documentation of the search also allows for critical appraisal of the methodology used and facilitates future updating of a review (1,2).

It has been found that large numbers of systematic review searches are inadequately documented and there is little consensus on best practices for reporting standards (3).

As part of the SuRe Info Project, we conducted a review of all current reporting standards relevant to HTAs and systematic reviews in addition to looking at the published literature on this topic in order to synthesize the evidence in this area and create a standard set of agreed upon recommendations.

We conducted a comprehensive search of Medline, Embase, and LISA (Library & Info Studies Abstracts) databases. We also examined the Equator Network (http://www.equator-network.org/) website. Reference lists of included studies and reporting guidelines were also consulted. Eleven reporting guidelines and eight studies were included in the review by two independent reviewers. Anything published before 2006, that was not a research article (other than the guidelines), and/or that did not provide new recommendations (that is, a review of another set of recommendations) was excluded.

After collecting data on the suggested reporting elements described in the literature, we pooled our results to create an overarching list of the most commonly recommended elements to describe and the most commonly recommended methods to use when documenting a comprehensive search. Not only did these elements pertain to documenting the search strategy for the final report, but they also pertained to the protocol and the abstract of a review.

It is hoped that this overview of the literature and compilation of the evidence will clarify some of the confusion that seems to exist when documenting and reporting searches and perhaps it will even help to reduce the existence of poorly described strategies in the research literature.