Advanced practice for children and young people: A systematic review with narrative summary

AimTo critically appraise and synthesise the current evidence related to the advanced practice nurse (APN) in the children and young people's healthcare setting.BackgroundA complex landscape of demand and change has influenced the healthcare delivery for children and young people. In the United Kingdom and internationally, governments have endorsed the need for workforce innovation with APN roles introduced to counter these challenges. However, little is known about the impact of these initiatives in the context of children and young people's health care.DesignSystematic review and narrative summary.Data sourcesCINAHL, MEDLINE, DARE, PubMed, Prospero and Cochrane Database of Systematic Reviews were searched for studies published in English language from July 1998 to 2018. Studies were selected based on key search terms and eligibility criteria.Review methodsThe selected studies were appraised using the Effective Public Health Practice Project for quantitative studies. An adapted version of the JBI data extraction tool for experimental/observational studies was used to extract the relevant key findings. This was conducted independently by two researchers.ResultsNine studies were included in the review. The review demonstrated roles were comparable in their clinical practice to medics yet offered higher levels of patient satisfaction, role modelling for staff and led practice initiatives to improve health literacy.ConclusionThis review demonstrates that APN roles in children and young people's health care provide clinical, organizational and professional benefits, with added value to organizations and patients, acting as role models and educators.ImpactThe findings from this review indicate further research is required to ascertain contextual issues that may influence the implementation of APNs. This research will impact APNs working with children and young people. Equally, it supports the evidence base for service commissioners outlining areas for future research

The future of child health services: new models of care

This report highlights what the problems are in current health care services for children and young people, and investigates how emerging new models of care could provide an opportunity to address these

Is bigger better? Lessons for large-scale general practice

The study examined the factors affecting their evolution and their impact on quality, staff and patient experience

Measuring and improving the quality of NHS care for children and young people

Children and young people (CYP) in the UK suffer worse health and well-being outcomes than their peers in comparable countries across a range of physical and mental health measures, including overall mortality and deaths from long-term conditions such as epilepsy, asthma and diabetes.1–6 While social determinants, in particular relatively high rates of child poverty, account for some of this mortality gap, there is growing evidence that many deaths could be prevented through more accessible and higher quality National Health Service (NHS) care.2 3 In addition, evidence suggests that the NHS care typically results in worse patient experience for young people aged 16–24 than older adults,7 and that there is sometimes objectively lower quality care for CYP than for adults. The UK ranked fourth out of 30 countries in a recent comparison of the quality of adult diabetes care, whereas the quality and outcomes of diabetes for patients aged 0–24 years lag well behind that of comparable countries.8 9 In addition to moral, public health and economic arguments for improving care quality for CYP, the UK also has legal obligations under the United Nations Convention on the Rights of the Child to provide the best healthcare possible (article 24) and to involve CYP in decisions that affect them (article 12).10–12 Validated and appropriate quality measures are necessary (but not sufficient) to improve care quality and health and well-being outcomes.13 CYP have historically been under-represented in many quality frameworks; for example, one 2015 study reported that 0/77 indicators in the Quality Outcomes Framework for primary care were applicable to CYP.14 Following the recommendations of the CYP Health Outcomes Forum,15 the number of indicators in the NHS Outcomes Framework has increased,16 and the perspectives of CYP using NHS services have been given greater weight in some settings.17 However, there has been limited response to many of the Forum’s recommendations, and many of the indicators that have been introduced are of limited benefit, as they have not been validated for this age group and/or CYP data are aggregated with those of older adults. Building on previous recommendations by the Chief Medical Officer for England1 and the CYP Health Outcomes Forum,15 and as a follow-up to the publication of the Royal College of Paediatrics and Child Health (RCPCH) services standards,18 19 the RCPCH initiated a 2-year project to agree on 5–10 core quality measures for acute general paediatric care. The final 2016 report20 represents an important advance in bringing together key principles for measuring and improving quality in acute general paediatric services (see box 1), but the project was not able to reach agreement on its original goal. One key barrier was the lack of a common language and framework for understanding the purpose of measuring quality, what should be measured and how; we attempt to address these concerns in the sections below and in box 1. Another recurring issue was the lack of knowledge about existing quality measures and data sources. This was addressed by convening a workshop in May 2017 to which each relevant national body was invited to submit their existing measures, as well as related challenges and priorities for future work. A summary of this material is presented in table 1. Lastly, a relative lack of primary research was noted in developing, validating and implementing appropriate quality measures.2

'Avoidable' mortality: a measure of health system performance in the Czech Republic and Slovakia between 1971 and 2008

BACKGROUND: Post-communist health care reforms and the break-up of Czechoslovakia have been studied from various perspectives, but little research has addressed the impact on health system performance. This paper investigates the quality and performance of the Slovak and Czech health systems before and after 1989, including the year of separation in 1993, using the concept of ‘avoidable’ mortality. METHODS: Age-standardized mortality rates for mortality from ‘avoidable’ and other (non-avoidable) causes have been calculated through indirect standardization to study national and regional trends between 1971 and 2008. RESULTS: The paper shows that ‘avoidable’ mortality in both countries has been continuously decreasing while mortality from other causes has remained unchanged or increased slightly. For some ‘avoidable’ conditions, mortality rates of the two countries converge while for others divergence can be observed, with either the Czech Republic or Slovakia performing better. CONCLUSION: Declines in overall ‘avoidable’ mortality suggest improvements in the health system’s performance and quality of care in both countries, compared with mortality from other causes where factors outside the control of the health care system may be stronger determinants. For conditions where ‘avoidable’ mortality rates stagnate or increase, more in-depth research should be carried out to identify problems in the delivery of timely and effective prevention and treatment, and to establish steps that would reduce the numbers of unnecessary deaths