Feasibility, acceptability, and effectiveness of young people-specific, integrated out-of-hospital services: a protocol for a systematic review

There are 1.8 billion young people in the world, more than ever before, providing an unprecedented opportunity for social and economic progress [1]. Estimates suggest that approximately 25% of the world’s population is between 10 and 24 years of age [2]. A report, based on the WHO’s 2004 Global Burden of Disease (GBD) study, recorded 236 million incident DALYs (disability-adjusted life years) in young people aged between 10 and 24 years, representing 15·5% of the total DALY burden for all age groups [3]. Often referred to as “young people,” this group undergoes rapid changes in biological, psychological, and social factors, making it an important period of transition in their lives. From a health system perspective, it is an important phase as investments in health of young people offer lasting benefits for the young people not only through their lifetime, but also pass on to the next generation. Good health outcomes at this age also prepare a healthy workforce much needed for economic growth in the climate of global financial uncertainties. For years, this distinct and demanding phase has been unrecognized by the health systems in many parts of the world, where there are different specialities for childhood and adult health services, but no dedicated services for young people [4]. However, this is changing and the need for services specifically tailored for this phase of transition in life is being increasingly recognized [5‐9]. Against a backdrop of increasing focus on unique health issues of young people, the growing complexity of their needs, and ever-increasing financial pressures on health systems, there is a need to deliver better care in a more effective, feasible, and acceptable way [10, 11].

Integrated care is one of the approaches suggested to achieve better patient care and greater efficiency from health delivery systems [12‐17]. By linking providers to integrated networks, integrated care offers promise to improve the efficiency of systems by optimizing resource allocation. World Health Organization (WHO) defines integrated care as “Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion” [18]. It covers a complex field, with many alternate terms like collaborative care, coordinated care, transmural care, seamless care, or comprehensive care.

Recent reports on health systems have focused attention on the integration of health care across traditional sectorial boundaries and on the increased provision of healthcare in out-of-hospital spaces [19, 20]. Out-of-hospital provision may include services with other pediatric services or more youth-specific services provided in a range of settings including schools. Although the impact of integrated services has been examined in the general population [21, 22], the implications of this for young people have not been systematically examined, and to date, there is no published systematic review which evaluates young people-specific, integrated out-of-hospital services. To fill this gap, we propose to undertake this systematic review with the objective to assess the effectiveness, feasibility, and acceptability of young people-specific integrated out-of-hospital services.

The review protocol is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidance [23]. The completed checklist can be found in Additional file 1. A pre-defined set of eligibility criteria will be used to screen studies for inclusion in the review (see Table 1).

To our knowledge, this will be the first review to synthesize evidence on the evaluation of young people-specific out-of-hospital integrated health services. The provision of youth-specific out-of-hospital integrated health services can improve service delivery and access, and the evidence synthesis of evaluation of such services can help identify models or key components of models which have been most effective, acceptable, and feasible. The findings of this review can help identify the areas where interventions for youth-specific integrated care are most effective, in terms of the settings, service delivery, and care models. Information about the characteristics of interventions will help policy makers, researchers, and health professionals in the design and selection of models of integrated health care for young people. Differences in the service patterns may guide on how to adapt in various “out-of-hospital” settings. We do recognize that the concept of “integrated” care is complex, and there is a lack of uniformity in its definition and interpretation. Also, the models of integrated care in itself are likely to be highly complex with multiple elements making it difficult to classify interventions. These are likely to be few of the challenges while interpreting the evidence on integrated services and summarizing it. Our review will also identify any gaps in the existing evidence to provide direction for future research.