What is the effectiveness of community diagnostic centres: a rapid review (preprint)

ABSTRACT

The COVID-19 pandemic directly impacted diagnostic services in the UK and globally. This exacerbated the rapid rise in demand for diagnostics that existed before the pandemic, resulting in significant numbers of patients requiring various diagnostic services and increased waiting times for diagnostics and treatment. In 2021, community diagnostic centres were launched in England. As diagnostic services account for over 85% of clinical pathways within the NHS and cost over six billion pounds per year, diagnostic centres across a broader range of diagnostic services may be effective, efficient, and cost-effective in the UK health sector. This rapid review aimed to identify and examine the evidence on the effectiveness of community diagnostic centres. A prior Research Evidence Map was used, along with the stakeholder input, to select a substantive focus for the rapid review. Comparative studies examining community diagnostic centres that accept referrals from primary care as a minimum were included. Prioritised outcomes included those relating to impact on capacity and pressure on secondary care, ensuring equity in uptake or access, and economic outcomes The review included evidence available up until August 2022. Twenty primary studies were included. Twelve individual diagnostic centres were evaluated across the 20 studies. Most studies evaluated diagnostic centres located within hospital settings. One study evaluated a mobile diagnostic ultrasound service. Most studies were specific to cancer diagnoses. Six studies covered multiple health conditions, which will have also included cancer. Other conditions reported included severe anaemia, fever of uncertain nature, and multiple sclerosis. A range of outcomes was identified. 11 studies conducted in Spain evaluated the same type of clinic i.e. Quick Diagnostic Unit and seven studies evaluated the same centre at different time intervals. No evidence relating to equity of access was identified. The evidence relating to effectiveness appeared mixed. There is evidence to suggest that diagnostic centres can reduce various waiting times, including time to surgical consultation, time from consultation to treatment, time from cancer suspicion to treatment, time from diagnosis to specialist consultation and time from diagnosis to treatment. Diagnostic centres could help reduce pressure on secondary care by avoiding hospitalisations in stable patients. Cost-effectiveness may depend on whether the diagnostic centre is running at full capacity. Factors that could determine the costs incurred by a centre include the diagnostic and clinical complexity of patients, and the characteristics of the unit including the number of staff and contribution of staff time.