Are overwhelmed health systems an inevitable consequence of covid-19? Experiences from China, Thailand, and New York State
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Background: Clinical guidelines aim to improve the safety and quality of patient care by providing clinicians with graded recommendations based on evidence of best practice. Objective: To evaluate the effects of the introduction of clinical guidelines for allied health professionals, and to estimate the effectiveness of the guideline dissemination and implementation strategies used. Methods: A comprehensive search of six electronic databases to June 2006 and the Cochrane Effective Practice and Organisation of Care database was conducted. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series studies were included if the intervention was aimed at implementing guidelines in the allied health professions. Articles were screened for eligibility and their methodological quality was assessed; data were extracted independently by two reviewers. Results: Fourteen studies met the inclusion criteria. The methodological quality varied greatly, with the proportion of quality criteria met ranging from 0 to 6 out of seven. In most studies, the effects reported for patient and process outcomes were small and in favour of the intervention group. Of the 14 included studies, 10 focused on educational interventions. Six of the 14 studies used a single intervention strategy and seven used a multi-faceted implementation strategy. One study compared both single and multi-faceted strategies. Multi-faceted interventions were no more effective than single intervention strategies and effects of the same strategy varied across trials. Conclusions: There is no evidence to support a set guideline implementation strategy for allied health professionals. When implementing clinical guidelines it is important to first identify specific barriers to change using theoretical frameworks of behaviour change and then develop strategies that deal with these barriers. When measuring the effectiveness of these strategies, professionals should consider the use of both patient and process outcomes and choose outcomes that reflect their aims.
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In March 2020, health system partners and public health agencies were concerned that a surge in COVID-19 patients might overburden the health system, as had been seen in China and New York City.
“In March 2020, there were concerns among health system partners and public health agencies that a surge in COVID-19 patients might overburden the health system, as seen in China and New York City [50, 51].”
From Evolution of clinical Health Information Exchanges to population health resources: a case study of the Indiana network for patient care (2025) · cites this paper as [51]
The ‘Mobilising resources’ section (page unavailable) reports that COVID-19 demand exceeded capacity in New York City and that China rapidly added staff and hospital beds in Wuhan. The ‘Effect of covid-19 on health services’ section (page unavailable) says New York’s health delivery systems were overwhelmed. The paper does not document concerns held by the citing document’s health system partners or public health agencies in March 2020, nor does it explicitly say China’s health system was overwhelmed. (LLM, conf=0.85)
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- Authors
- Tangcharoensathien, V., Bassett, M. T., Meng, Q., & Mills, A.
- Affiliations
- Harvard University (US)
- Peking University (CN)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Tangcharoensathien, Viroj
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2021-01-22
- Volume
- 372
- Pages
- n83
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC8896039
- OpenAlex
- W3121928260
- Cited by
- 122
- References
- 28
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 16 · 2023: 33 · 2022: 43 · 2021: 19
- FWCI
- 24.05
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Challenges
- Keywords
- guideline implementation, allied health professionals, guideline dissemination, educational intervention, barriers to change
- MeSH terms
- COVID-19, SARS-CoV-2, China, Communicable Disease Control, Delivery of Health Care, Humans, New York, Thailand, Pandemics
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