Table 3 Summary of findings from quantitative articles

Gale et al. 2012 [3]

National reorganisation of neonatal services in England into managed clinical neonatal networks to improve access to specialist care for pre-term births

Yes

Improvement in primary outcomes, less success in secondary outcomes

Increase in

•Proportion of babies born at 27–28 weeks gestation at hospitals providing the highest volume of specialist care (18 % to 49 %; risk difference 31 %; 95 % CI [28 % to 33 %]; OR: 4.30; 95 % CI [3.83 to 4.82]; p < 0.001).

•Proportion of babies undergoing acute and late postnatal transfer in England (7 vs. 12 and 18 % vs. 22 %, respectively; p < 0.001).

Greene et al. 2009 [31]

Progressive implementation of multiple quality improvement strategies including; guideline development and dissemination; education; clinical audit, feedback and benchmarking; encouragement of multidisciplinary team working; task redesign; and care pathway redesign

Yes

Rapid improvement in simple indicators, slow improvement in complex indicators

Improvements (all p < 0.001) in measurement/assessment and recording of:

•Glycated haemoglobin

•Blood pressure

•Cholesterol

•Smoking status

•Creatinine

•Foot vascular and neurological status

•Retinal screening

Hamilton et al. 2005 [4]

Establishment of a managed clinical network for cardiac services in a predominantly rural area to improve patient care

Some

Improvement in 11 indicators (2 significant, 9 non-significant); no improvement in 5 indicators

Improvement in:

•Pain to needle time <90 min; p = 0.05

•70 % on beta-blockade at 6 months post myocardial infarction; p = 0.05

McClellan et al. 1999 [33]

A multifaceted intervention through a clinical network to improve haemodialysis adequacy

Yes

Improvement in all primary outcomes

•Improvement in Urea Reduction Ratios (URRs) from 63 % to 67 % (p < 0.001)

•Decrease in the proportion of under-dialysed patients from 56.6 % to 31.7 % (chi-squared for trend, p < 0.0001).

McCullough et al. 2014 [30]

Establishment of the Sarcoma Managed Clinical Network to improve the quality of diagnosis, treatment and care of sarcoma patients including facilitating national multidisciplinary discussion of all sarcoma cases, registering case details and provision of care by a multidisciplinary team

Some

Improvement in all primary outcomes, but decline in some secondary outcomes

•Decreased time interval from referral to initial assessment by the service from median 19.5 days to 10 days.

•Increase in proportion of patients undergoing investigation with a MRI scan prior to excision of the sarcoma from 67 % to 86 % a (p = 0.0009).

•Increase in proportion of patients undergoing appropriate biopsy from 57 % to 79 % (p = 0.006).

•Increase in complete resection margins from 48 % to 81 % (p < 0.001).

Ray-Coquard et al. 2002 [6]

Implementation of cancer clinical practice guidelines (CPGs) through a regional clinical network

Some

Improvement in compliance to some clinical guidelines but not all

Compliance of overall treatment sequences post-implementation of clinical practice guidelines in

Network hospitals:

•Colon cancer 46 %; 95 % CI [30 % to 54 %] (56 out of 123) vs. 14 %; 95 % CI [7 % to 21 %] (14 out of 103); p < 0.001

•Breast cancer 36 %; 95 % CI [30 % to 42 %] (126 out of 346) vs. 12 %; 95 % CI [8 % to 16 %] (34 out of 282); p < 0.001

Control group:

•No significant difference

Ray-Coquard et al. 2005 [7]

Sustained adherence to cancer clinical practice guidelines within a regional clinical network

Yes

Sustained improvement in compliance to clinical guidelines

Compliance of medical decisions with clinical practice guidelines at 3-year follow-up in:

Network hospitals:

•Colon cancer 73 %; 95 % CI [67 % to 79 %] v 56 %; 95 % CI [49 % to 63 %] respectively; p = 0.003

•Breast cancer 36 %; 95 % CI [31 % to 41 %] v 40 %; 95 % CI [35 % to 44 %] respectively; p = 0.24

Control group:

•Colon cancer 67 % 95 % CI [58 %–76 %] v 38 %; 95 % CI [29 %–47 %] respectively; p = 0.001

•Breast cancer 4 %; 95 % CI [1 %–7 %] v 7 %; 95 % CI [3 %–11 %] respectively; p = 0.19.

Spence & Henderson-Smart 2010 [32]

A multifaceted intervention through a clinical network to support practice change and close the evidence-practice gap for newborn pain management

Some

Improvement in several primary outcomes with a process for sustainability established for goals not achieved

Increase in:

•Percentage of infants receiving sucrose for procedural pain (41 % to 61 %; p < 0.005)

•Staff awareness of a clinical practice guideline for the management of newborn pain (61 % to 86 %; chi square = 73.8, d.f. 1, p = 0.000)

•Family awareness of infant pain and strategies to manage the pain (19 % to 48 %; chi square = 52.3, d.f. 1, p = 0.000).

Tideman et al. 2014 [34]

Establishment of a regionalised integrated Cardiovascular clinical network to reduce mortality in patients with acute myocardial infarction in hospitals in a rural setting

Yes

Improvement in all primary outcomes

•Decrease in 30-day mortality among patients presenting to hospitals integrated into the clinical network (13.93 % vs 8.92 %; p < 0.001).

•22 % relative odds reduction in 30-day mortality compared with patients presenting to rural centres outside the clinical network (OR, 0.78; 95 % CI, 0.65–0.93; p = 0.007).

•Increased rate of transfer of patients to metropolitan hospitals (before ICCNet, 1102/2419 (45.56 %) vs. after ICCNet, 2100/3211 (65.4 %); p < 0.001).