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REGIONALIZATION FOR HEALTH IMPROVEMENT: A SYSTEMATIC REVIEW
Autor
Afiliación
Universidade de Brasília. Faculdade de Ciências da Saúde. Brasília, DF, Brasil / Fundação Oswaldo Cruz. Fiocruz Brasília. Brasília, DF, Brasil.
Fundação Oswaldo Cruz. Fiocruz Brasília. Brasília, DF, Brasil.
Universidade Federal do Sergipe. Departamento de Medicina. Lagarto, SE, Brasil.
Universidade de Brasília. Faculdade de Ceilândia. Brasília, DF, Brasil.
Fundação Oswaldo Cruz. Fiocruz Brasília. Brasília, DF, Brasil.
Universidade Federal do Sergipe. Departamento de Medicina. Lagarto, SE, Brasil.
Universidade de Brasília. Faculdade de Ceilândia. Brasília, DF, Brasil.
Resumen en ingles
Regionalization is the integrated organization of a healthcare system, wherein regional structures
are responsible for providing and administrating health services in a specific region. This
method was adopted by several countries to improve the quality of provided care and to properly
utilize available resources. Thus, a systematic review was conducted to verify effective
interventions to improve health and management indicators within the health services regionalization.
The protocol was registered in PROSPERO (CRD42016042314). We performed a
systematic search in databases during February and March 2017 which was updated in October
2020. There was no language or date restriction. We included experimental and observational
studies with interventions focused on regionalization-related actions, measures or
policies aimed at decentralizing and organizing health offerings, rationalizing scarce capital
and human resources, coordinating health services. A methodological assessment of the
studies was performed using instruments from the Joanna Briggs Institute and GRADE was
also used to assess outcomes. Thirty-nine articles fulfilled the eligibility criteria and sixteen
interventions were identified that indicated different degrees of recommendations for improving
the management of health system regionalization. The results showed that regionalization
was effective under administrative decentralization and for rationalization of resources. The
most investigated intervention was the strategy of concentrating procedures in high-volume
hospitals, which showed positive outcomes, especially with the reduction of hospitalization
days and in-hospital mortality rates. When implementing regionalization, it must be noted that
it involves changes in current standards of health practice and in the distribution of health
resources, especially for specialized services.
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