Community hospitals in selected high income countries: a scoping review of approaches and models

Problem

Despite their long history in the UK, there is no single definition of a community hospital. In this review we seek to understand the nature and scope of service provision in community hospitals in selected high-income countries.

Approach

We undertook a scoping review of literature on community hospitals published from 2005 to 2014, guided by a working definition of community hospitals. Data were extracted on a range of features of the hospital model and the services provided. Data were analysed following the principles of narrative synthesis, to report on services, workforce, ownership and the relationship between the community hospital and other healthcare services.

Findings

75 studies were included in the review from ten countries. Community hospitals provide services covering the spectrum of care provision, from preventative and primary, to inpatient and outpatient medical and surgical care. The wide diversity of provision appeared to reflect local needs. Community hospitals are staffed by a mixture of general practitioners, generalist and specialist nurses, allied health professionals and healthcare assistants. Most community hospitals identified were under the responsibility of public authorities. We found many examples of collaborative working with other healthcare organisations. This was reported to result from their role in the middle of the patient pathway, from colocation of different services at a single place, through shared workforce with primary care and collaboration with acute specialists. Several studies reported the use of telemedicine to facilitate collaboration between community hospital staff and specialists.

Consequences

Community hospitals are able to provide a diverse range of services, responding to different geographical and health system contexts. The collaborative working between community hospital staff with those from other healthcare organisations may be particularly important in the design of future models of care delivery, where emphasis is placed on continuity of care, integrative working and patient experience.