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首页> 外文期刊>BMC Health Services Research >Development of the Tiers of Service framework to support system and operational planning for children’s healthcare services
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Development of the Tiers of Service framework to support system and operational planning for children’s healthcare services

机译：支持服务框架层的发展，以支持儿童医疗保健服务的系统和运营规划

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Providing access to pediatric healthcare services in British Columbia, Canada, presents unique challenges given low population densities spread across large geographic distances combined with a lack of availability of specialist providers in remote areas, leading to quality of care shortcomings and inequalities in care delivery. The study objective was to develop a framework that provides a common language and methodology for defining and planning child and youth healthcare services across the province. The framework was developed in two phases. In Phase 1, a literature and jurisdictional review was completed using the following inclusion criteria: (i) description of a framework focusing on organizing service delivery systems (ii) that supports health service planning, (iii) includes specialty or subspecialty services and (iv) has been published since 2008. In Phase 2, a series of meetings with key provincial stakeholders were held to receive feedback on the developed Tiers of Service framework versions that were based on the literature and jurisdictional review and adjusted to the British Columbian health care context. The final version was endorsed by the Child Health BC Steering Committee. Ten medical articles and thirteen jurisdictional papers met the established selection criteria and were included in this study. Most frameworks were developed by the Australian national or state jurisdictions and published in jurisdictional papers (n?=?8). Frameworks identified in the medical literature were mainly developed in Canada (n?=?3) and the US (n?=?3) and focused on maternity, neonatal, critical care and oncology services. Based on feedback received from the expert group, the framework was expanded to include community-based services, prevention and health determinants. The final version of the Tiers of Service framework describes the specific services to be delivered at each tier, which are categorized as Tier 1 (community services) through Tier 6 (sub-specialized services). Two consecutive steps were identified to effectively use the framework for operational and system planning: (i) development of a ‘module’ outlining the?responsibilities and requirements to be delivered at each tier; and?(ii) assessment of services provided at the health care facility against those described in the module, alignment to a specific tier, identification of gaps at the local, regional and provincial level, and implementation of quality improvement initiatives to effectively address the gaps. The benefits of the Tiers of Service framework and accompanying modules for health service planning are being increasingly recognized. Planning and coordinating pediatric health services across the province will help to optimize flow and improve access to high-quality services for children living in British Columbia.
机译：提供加拿大不列颠哥伦比亚省的儿科医疗保健服务的机会，呈现出独特的挑战，鉴于跨越大型地理距离的低人口密度结合偏远地区的专业提供商缺乏可用性，导致护理缺点和护理不等式的优质。该研究目标是制定一个框架，为全省界定和规划儿童和青少年保健服务提供共同语言和方法。该框架是在两个阶段开发的。在第1阶段，使用以下纳入标准完成文献和司法审查：（i）专注于组织支持健康服务计划的服务交付系统（II）的框架描述，（iii）包括专业或亚专业服务和（IV ）自2008年以来已发表。在第2阶段，举行了一系列与关键省利益攸关方的会议，以获得关于基于文学和管辖权审查的服务框架版本的反馈，并调整为不列颠哥伦比亚医疗保健背景。最终版本由儿童卫生BC指导委员会认可。十篇医学文章和十三条司法论文符合了既定的选择标准，并纳入本研究。大多数框架是由澳大利亚国家或国家司法管辖区制定的，并在司法论文中发表（n？=？8）。在医学文献中确定的框架主要在加拿大（N？=？3）和美国（n？=？3），并专注于产假，新生儿，关键护理和肿瘤学服务。基于从专家组收到的反馈，框架被扩展为包括基于社区的服务，预防和健康决定因素。服务框架层的最终版本描述了在每个层的每个层交付的特定服务，该服务将通过第6层（专用服务）分类为Tier 1（社区服务）。确定了两个连续步骤以有效地利用操作和系统规划框架：（i）开发“模块”概述的？职责和要求在每个层交付; ㈡对卫生保健设施提供的服务的评估对模块中描述的那些，对当地，区域和省级的特定层，确定差距以及实施质量改进措施，以有效解决空白。越来越识别服务框架层和陪同健康服务规划的陪同模块的好处。全省规划和协调儿科卫生服务将有助于优化流量，并改善居住在不列颠哥伦比亚省的儿童的高质量服务。

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