title: Does radiography advanced practice improve patient outcomes and health service quality? A systematic review.
abstract: OBJECTIVE
  To investigate the impact of radiographer advanced practice on patient outcomes and health service quality.
  
  
  METHODS
  Using the World Health Organization definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs, and data were systematically extracted using electronic data extraction pro forma.
  
  
  RESULTS
  407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n = 7) focusing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The articles were generally considered to be of low-to-moderate quality, with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, the included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No articles reported data relating to time to diagnosis, time to recovery or patient mortality.
  
  
  CONCLUSIONS
  Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited.
  
  
  CONCLUSIONS
  This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality.
authors.affiliation: Faculty of Health Studies, University of Bradford, Bradford, UK.
authors.forename: Maryann
authors.initials: M
authors.lastname: Hardy
authors.affiliation: Faculty of Health Studies, University of Bradford, Bradford, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Johnson
authors.affiliation: Faculty of Health Studies, University of Bradford, Bradford, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Sharples
authors.affiliation: Faculty of Health Studies, University of Bradford, Bradford, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Boynes
authors.affiliation: Faculty of Health Studies, University of Bradford, Bradford, UK.
authors.forename: Donna
authors.initials: D
authors.lastname: Irving
mesh_terms: D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D038622:Internationality; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000191:economics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000191:economics / Q000706:statistics & numerical data*; D011859:Radiography / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D061665:Time-to-Treatment / Q000191:economics / Q000706:statistics & numerical data*