The physical environment and its effect on health outcomes: a systematic review.

Objective: The study aims to identify and review the latest existing knowledge about evidence- based design (EBD) for healthcare architecture and determine the extent to which such findings pertain to the overarching goals proposed by the Institute of Medicine (IOM).Background: There is increasing knowledge regarding influences of healthcare physical environments on health and well-being outcomes. The demand for more evidence has steadily grown, and systematic literature reviews have gained increased importance in the healthcare design field.Research question: A systematic literature review was performed according to the guidelines proposed by The Swedish Agency for Health Technology Assessment and Social Services Assessment. Specific aims included evaluating the current status of research relating to evidence-based healthcare architecture and determining the extent to which such evidence corresponds to the key goals established by the IOM.Methods: A systematic literature review with a Boolean search strategy was performed using the following databases: CINAHL, Medline, SCOPUS, Cochrane library, and Web of Science. The time period covered was 2010-2018. The reference lists of articles obtained from keyword searches were then examined to identify additional relevant studies. The articles retrieved have been screened for eligibility for inclusion, and the final retained articles have been evaluated with descriptive statistics to identify which IOM quality categories are addressed, what type of healthcare settings, physical environment intervention and target groups are investigated, and what types of research design and methodology have been implemented. Furthermore, two researchers are independently assessing the quality of the material retained. This data is part of an ongoing project therefore, preliminary results are reported.Results: A total of 4546 articles were retrieved and screened for eligibility for inclusion, resulting in 688 retained articles published since 2010. Of these 92 has been analyzed until now with descriptive statistics and results suggest that the most frequently cited IOM goals are related to health (84%) and safety (46%), person-centred approach (29%) and effectiveness of care (28%). Moreover, research has been performed across acute care and overall hospital settings (22 and 21%).Conclusion: The systematic literature review indicates that the body of knowledge relating to EBD is clearly growing, and the main focus is on design interventions to improve the health and safety of patients across acute care units. Lack of evidence are instead found in regard to other IOM aspects such as, equality of care and patients’ participation