Identifying adverse events indicative of fragmented healthcare across multiple medical specialties: a scoping review

Introduction: Fragmented healthcare is defined as poorly coordinated care increasing the risk of adverse events such as economic inefficiency, inequality in health, and depersonalization of the patient. However, healthcare does not always become fragmented when involving more specialties.<br/><br/>Objective: To identify types of adverse events that the scientific health literature associates as indicative of fragmented healthcare across medical specialties.<br/><br/>Methods: The search strategy followed the Joanna Briggs Institute methodology for conducting a Scoping review. The search was applied to MEDLINE, Scopus, and Embase, limited to peer-reviewed published studies in English and Scandinavian from 2014 to the date of extraction. Covidence had been used to conduct the title, abstract, and full-text screening, and the extraction of metadata and excerpts of adverse events from the included studies. The extracted excerpts underwent a narrative synthesis to categorize adverse events that indicate fragmented healthcare.<br/>Results: 8,261 hits have been exported and screened. The preliminary results from the narrative analysis identify 10 groups of adverse events indicative of fragmented healthcare: 1) poor communication between healthcare providers, 2) delays in receiving or providing diagnosis and treatment, 3) interruptions in the continuity of care, 4) issues with referral processes, 5) errors in medication management, 6) neglect of psycho-social factors in care planning, 7) adverse outcomes due to inadequate care coordination, 8) barriers to care access and availability, 9) unclear clinical responsibility among providers, and 10) lack of patient involvement or continuity in care relationship.<br/>