{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T15:16:18Z","timestamp":1774538178119,"version":"3.50.1"},"reference-count":60,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Funds through FCT \u2013 Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia, I.P., within the project RISE-Health","award":["UID\/06397\/2025"],"award-info":[{"award-number":["UID\/06397\/2025"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,12]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ambulatory care sensitive conditions (ACSC) are health conditions that can be adequately managed in the outpatient setting. Timely treatment and interventions may avoid the need for hospitalisation and emergency department visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We aimed to identify ACSC lists developed for European populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review. We included primary studies that aimed to develop a list of ACSC for the general population or subpopulations within European countries. Studies reporting a formal methodology were eligible. Systematic or narrative reviews, and protocols were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>PubMed, Web of Science and Scopus were searched on 21 October 2025. Data search was complemented with the search for \u2018ambulatory OR preventable\u2019 in the websites of the WHO Regional Office for Europe, OECD (Organisation for Economic Co-operation and Development) and NHSOF (British National Health Service Outcomes Framework).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>\n                      Two reviewers independently collected data on type of population, geographical coverage, bibliographic support, use of qualitative or quantitative methods, ontology system, as well as the identified conditions per list. Data on methodological characteristics was qualitatively synthesised. Conditions identified as ACSC were aggregated under International Classification of Diseases 10th Revision (ICD-10). Each primary study with Delphi component was assessed using the Diamond\n                      <jats:italic>et al<\/jats:italic>\n                      risk of bias tool. Studies with a qualitative component were assessed using Joanna Briggs Institute (JBI) checklist for qualitative research.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 12 articles were included. Six European countries have lists developed for general populations. A total of 263 unique ACSC have been defined (932 codes) for the general populations. For the paediatric age, 28 conditions (70 codes) were identified, while 37 diagnoses (58 codes) were listed for the nursing home population. Most commonly identified ACSCs were infection-related, chronic cardiovascular or respiratory diseases. Delphi methods were employed in eight studies, with a median of 3 (2\u20133.25) rounds with a median of 36.5 (32.8\u201342.5) panellists. Risk of bias assessment yielded a quality score of 2 (out of 4) for six studies and of 3 for the remaining two studies. Remaining studies were assessed with JBI yielding a median 6.5 (6.0\u20137.0) points (out of 10 possible points). The most used code system was ICD-10. Use of nationwide real-world databases was limited to six studies. No identified ACSC lists explicitly fulfilled all criteria defined by Solberg and Weissman for ACSC establishment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The evidence on ambulatory care sensitive conditions is heterogeneous and derives from different methodologies and covers six European countries. Most lists are diagnosis-based, aim at national, general populations and include Delphi components to define ACSC. We speculate that the future inclusion of primary care data could enhance ACSC evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42022349270.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-112777","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T14:20:35Z","timestamp":1774534835000},"page":"e112777","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Identifying ambulatory care sensitive conditions: a systematic review of studies defining sets of diseases with avoidable hospitalisations in European countries"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6201-6364","authenticated-orcid":false,"given":"Daniel","family":"Martinho-Dias","sequence":"first","affiliation":[{"name":"RISE-Health, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"given":"Bernardo","family":"Sousa-Pinto","sequence":"additional","affiliation":[{"name":"RISE-Health, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"given":"Mariana","family":"Canela-Pais","sequence":"additional","affiliation":[{"name":"RISE-Health, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"given":"Ana","family":"Garrido-Oliveira","sequence":"additional","affiliation":[{"name":"USF Ao Encontro da Sa\u00fade, Unidade Local de Sa\u00fade do M\u00e9dio Ave, Santo Tirso, Portugal"}]},{"given":"Dulce","family":"Pinto","sequence":"additional","affiliation":[{"name":"Unidade Local de Sa\u00fade do Alto Minho EPE, Viana do Castelo, Portugal"}]},{"given":"Altamiro","family":"Costa-Pereira","sequence":"additional","affiliation":[{"name":"RISE-Health, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"given":"Tiago","family":"Taveira-Gomes","sequence":"additional","affiliation":[{"name":"RISE-Health, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"given":"Jo\u00e3o Almeida","family":"Fonseca","sequence":"additional","affiliation":[{"name":"RISE-Health, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal"}]},{"given":"Ant\u00f3nio Jos\u00e9 de Almeida","family":"Soares","sequence":"additional","affiliation":[{"name":"RISE-Health, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal"}]}],"member":"239","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"2026032607201891000_16.3.e112777.1","doi-asserted-by":"crossref","DOI":"10.1016\/j.hpopen.2021.100030","article-title":"Hospitalization for ambulatory care sensitive conditions: What conditions make inter-country comparisons possible?","volume":"2","author":"Rocha","year":"2021","journal-title":"Health Policy Open"},{"key":"2026032607201891000_16.3.e112777.2","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1177\/1403494820944722","article-title":"Mortality related to ambulatory care sensitive hospitalisations in Finland","volume":"48","author":"Partanen","year":"2020","journal-title":"Scand J Public Health"},{"key":"2026032607201891000_16.3.e112777.3","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.20.2.225"},{"key":"2026032607201891000_16.3.e112777.4","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6963-7-134","article-title":"Preventable hospitalization and access to primary health care in an area of Southern Italy","volume":"7","author":"Rizza","year":"2007","journal-title":"BMC Health Serv Res"},{"key":"2026032607201891000_16.3.e112777.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g6423","article-title":"Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study","volume":"349","author":"Harrison","year":"2014","journal-title":"BMJ"},{"key":"2026032607201891000_16.3.e112777.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.respe.2014.04.005"},{"key":"2026032607201891000_16.3.e112777.7","unstructured":"Regula o \u00edndice de desempenho da equipa multiprofissional das unidades de sa\u00fade familiar de modelo B, e a atribui\u00e7\u00e3o dos incentivos institucionais a estas e \u00e0s unidades de cuidados de sa\u00fade personalizados, Portaria n.\u00b0 411-A\/2023. 2023."},{"key":"2026032607201891000_16.3.e112777.8","unstructured":"WHO . Assessing Health Services Delivery Performance with Hospitalizations for Ambulatory Care Sensitive Conditions. Health Services Delivery Programme, Division of Health Systems and Public Health. 2016."},{"key":"2026032607201891000_16.3.e112777.9","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzv004"},{"key":"2026032607201891000_16.3.e112777.10","unstructured":"Marshall MLS , Mattke S , Panel M of the OHPP and PC. Selecting Indicators for the Quality of Health Promotion . Prevention and primary care at the health systems level in oecd countries, Available: https:\/\/www.oecd.org\/els\/health-systems\/33865865.pdf.2004"},{"key":"2026032607201891000_16.3.e112777.11","unstructured":"National Health Service (NHS) . Emergency admissions for acute conditions that should not usually require hospital admission, 2022. Available: https:\/\/digital.nhs.uk\/data-and-information\/publications\/statistical\/nhs-outcomes-framework\/march-2022\/domain-3---helping-people-to-recover-from-episodes-of-ill-health-or-following-injury-nof\/3a-emergency-admissions-for-acute-conditions-that-should-not-usually-require-hospital-admission"},{"key":"2026032607201891000_16.3.e112777.12","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckt203"},{"key":"2026032607201891000_16.3.e112777.13","unstructured":"AHRQ . Prevention Quality Indicators, 2022. Available: https:\/\/qualityindicators.ahrq.gov\/measures\/PQI_TechSpec"},{"key":"2026032607201891000_16.3.e112777.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-020-5071-4","article-title":"Direct and lost productivity costs associated with avoidable hospital admissions","volume":"20","author":"Rocha","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"2026032607201891000_16.3.e112777.15","doi-asserted-by":"publisher","DOI":"10.1007\/s11845-012-0810-0"},{"key":"2026032607201891000_16.3.e112777.16","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-020-05620-9","article-title":"Defining ambulatory care sensitive conditions for adults in Portugal","volume":"20","author":"Sarmento","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"2026032607201891000_16.3.e112777.17","unstructured":"Fund TK , Tian Y , Gao H , et al . Emergency hospital admissions for ambulatory care-sensitive conditions: identifying the potential for reductions. The King\u2019s Fund 2021."},{"key":"2026032607201891000_16.3.e112777.18","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.12.1.162"},{"key":"2026032607201891000_16.3.e112777.19","first-page":"359","article-title":"The Minnesota project: a focused approach to ambulatory quality assessment","volume":"27","author":"Solberg","year":"1990","journal-title":"Inquiry"},{"key":"2026032607201891000_16.3.e112777.20","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1992.03490170060026"},{"key":"2026032607201891000_16.3.e112777.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026032607201891000_16.3.e112777.22","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmu053"},{"key":"2026032607201891000_16.3.e112777.23","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-052455","article-title":"Bridging the impactibility gap in population health management: a systematic review","volume":"11","author":"Orlowski","year":"2021","journal-title":"BMJ Open"},{"key":"2026032607201891000_16.3.e112777.24","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2022.898359","article-title":"Interventions to Prevent Potentially Avoidable Hospitalizations: A Mixed Methods Systematic Review","volume":"10","author":"Lyhne","year":"2022","journal-title":"Front Public Health"},{"key":"2026032607201891000_16.3.e112777.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2008.11.001"},{"key":"2026032607201891000_16.3.e112777.26","doi-asserted-by":"crossref","DOI":"10.3390\/healthcare12171757","article-title":"Delphi Technique on Nursing Competence Studies: A Scoping Review","volume":"12","author":"Furtado","year":"2024","journal-title":"Healthcare (Basel)"},{"key":"2026032607201891000_16.3.e112777.27","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000032829","article-title":"Use of Delphi in health sciences research: A narrative review","volume":"102","author":"Shang","year":"2023","journal-title":"Medicine (Baltimore)"},{"key":"2026032607201891000_16.3.e112777.28","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan\u2014a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev"},{"key":"2026032607201891000_16.3.e112777.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.12.002"},{"key":"2026032607201891000_16.3.e112777.30","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1017\/S1463423609990211","article-title":"Prioritizing ambulatory care sensitive hospital admissions in England for research and intervention: a Delphi exercise","volume":"11","author":"Purdy","year":"2010","journal-title":"Primary Health Care"},{"key":"2026032607201891000_16.3.e112777.31","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1093\/eurpub\/ckz081","article-title":"Ambulatory care-sensitive emergency department cases: a mixed methods approach to systemize and analyze cases in Germany","volume":"29","author":"Schuettig","year":"2019","journal-title":"Eur J Public Health"},{"key":"2026032607201891000_16.3.e112777.32","unstructured":"Office WHO-E . Ambulatory care sensitive conditions in Latvia. 2015."},{"key":"2026032607201891000_16.3.e112777.33","doi-asserted-by":"publisher","DOI":"10.1177\/135581960000500407"},{"key":"2026032607201891000_16.3.e112777.34","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/S0213-9111(01)71532-4","article-title":"Hospitalizations due to ambulatory care sensitive conditions: selection of diagnostic codes for Spain","volume":"15","author":"Caminal","year":"2001","journal-title":"Gac Sanit"},{"key":"2026032607201891000_16.3.e112777.35","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/14.3.246"},{"key":"2026032607201891000_16.3.e112777.36","first-page":"169","article-title":"Potentially avoidable hospitalisation in Bologna, 1997-2000: temporal trend and differences by income level","volume":"30","author":"Pirani","year":"2006","journal-title":"Epidemiol Prev"},{"key":"2026032607201891000_16.3.e112777.37","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1016\/j.healthpol.2015.08.007","article-title":"Which hospitalisations are ambulatory care-sensitive, to what degree, and how could the rates be reduced? Results of a group consensus study in Germany","volume":"119","author":"Sundmacher","year":"2015","journal-title":"Health Policy"},{"key":"2026032607201891000_16.3.e112777.38","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-018-1360-z","article-title":"Hospitalisation after birth of infants: cross sectional analysis of potentially avoidable admissions across England using hospital episode statistics","volume":"18","author":"Jones","year":"2018","journal-title":"BMC Pediatr"},{"key":"2026032607201891000_16.3.e112777.39","doi-asserted-by":"crossref","DOI":"10.12688\/f1000research.73875.1","article-title":"Nursing home-sensitive conditions: analysis of routine health insurance data and modified Delphi analysis of potentially avoidable hospitalizations","volume":"10","author":"Bohnet-Joschko","year":"2021","journal-title":"F1000Res"},{"key":"2026032607201891000_16.3.e112777.40","doi-asserted-by":"crossref","first-page":"189","DOI":"10.26641\/2307-0404.2020.4.221711","article-title":"Estimates of potentially preventable hospitalizations for ambulatory care sensitive conditions in Ukraine","volume":"25","author":"Lekhan","year":"2020","journal-title":"Medicni Perspektivi (Medical Perspectives)"},{"key":"2026032607201891000_16.3.e112777.41","article-title":"Use of Delphi in health sciences research: A narrative review","volume":"102","author":"Shang","year":"2023","journal-title":"Medicine (Abingdon)"},{"key":"2026032607201891000_16.3.e112777.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2018.03.007"},{"key":"2026032607201891000_16.3.e112777.43","doi-asserted-by":"crossref","DOI":"10.1016\/j.mex.2021.101401","article-title":"Preparing, conducting, and analyzing Delphi surveys: Cross-disciplinary practices, new directions, and advancements","volume":"8","author":"Beiderbeck","year":"2021","journal-title":"MethodsX"},{"key":"2026032607201891000_16.3.e112777.44","doi-asserted-by":"crossref","unstructured":"Fink-Hafner D , Dagen T , Dou\u0161ak M , et al . Delphi method. Adv Meth Stat 2019;16. doi:10.51936\/fcfm6982","DOI":"10.51936\/fcfm6982"},{"key":"2026032607201891000_16.3.e112777.45","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-5-37","article-title":"Stability of response characteristics of a Delphi panel: application of bootstrap data expansion","volume":"5","author":"Akins","year":"2005","journal-title":"BMC Med Res Methodol"},{"key":"2026032607201891000_16.3.e112777.46","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1097\/JHQ.0000000000000145","article-title":"Trends in Avoidable Hospitalizations for Diabetes: Experience of a Large Clinically Integrated Health Care System","volume":"41","author":"Yaqoob","year":"2019","journal-title":"J Healthc Qual"},{"key":"2026032607201891000_16.3.e112777.47","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1007\/s11897-012-0117-5","article-title":"Trends in heart failure hospitalizations","volume":"9","author":"Fida","year":"2012","journal-title":"Curr Heart Fail Rep"},{"key":"2026032607201891000_16.3.e112777.48","doi-asserted-by":"crossref","first-page":"2240","DOI":"10.1111\/jgs.16636","article-title":"National Trends in Potentially Preventable Hospitalizations of Older Adults with Dementia","volume":"68","author":"Anderson","year":"2020","journal-title":"J Am Geriatr Soc"},{"key":"2026032607201891000_16.3.e112777.49","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-015-1137-0","article-title":"Admissions for chronic ambulatory care sensitive conditions - a useful measure of potentially preventable admission?","volume":"15","author":"Longman","year":"2015","journal-title":"BMC Health Serv Res"},{"key":"2026032607201891000_16.3.e112777.50","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/cks053"},{"key":"2026032607201891000_16.3.e112777.51","first-page":"e126","article-title":"Continuity of outpatient care and avoidable hospitalization: a systematic review","volume":"25","author":"Kao","year":"2019","journal-title":"Am J Manag Care"},{"key":"2026032607201891000_16.3.e112777.52","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-1956"},{"key":"2026032607201891000_16.3.e112777.53","doi-asserted-by":"crossref","first-page":"169","DOI":"10.5123\/S1679-49742017000100018","article-title":"Hospitalizations of Brazilian children under fiver years old: a systematic review","volume":"26","author":"Pedraza","year":"2017","journal-title":"Epidemiol Serv Saude"},{"key":"2026032607201891000_16.3.e112777.54","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-024-18472-3","article-title":"Exploring differences in the utilization of the emergency department between migrant and non-migrant populations: a systematic review","volume":"24","author":"Acquadro-Pacera","year":"2024","journal-title":"BMC Public Health"},{"key":"2026032607201891000_16.3.e112777.55","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ejim.2017.04.014","article-title":"What is inappropriate hospital use for elderly people near the end of life? A systematic review","volume":"42","author":"Cardona-Morrell","year":"2017","journal-title":"Eur J Intern Med"},{"key":"2026032607201891000_16.3.e112777.56","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s43678-023-00477-3","article-title":"Limited evidence that emergency department care is more costly than other outpatient settings for low-acuity conditions: a systematic review","volume":"25","author":"Stephen","year":"2023","journal-title":"CJEM"},{"key":"2026032607201891000_16.3.e112777.57","unstructured":"Administra\u00e7\u00e3o Central do Sistema de Sa\u00fade IP . Bilhete de Identidade de Indicadores de Monitoriza\u00e7\u00e3o e Contratualiza\u00e7\u00e3o, 2018. Available: https:\/\/sdm.min-saude.pt\/bi.aspx?id=339&clusters=S"},{"key":"2026032607201891000_16.3.e112777.58","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2296-10-55","article-title":"GPs\u2019 reasons for referral of patients with chest pain: a qualitative study","volume":"10","author":"Bruyninckx","year":"2009","journal-title":"BMC Fam Pract"},{"key":"2026032607201891000_16.3.e112777.59","doi-asserted-by":"crossref","DOI":"10.1186\/s12875-019-1053-1","article-title":"General practitioners referring patients to specialists in tertiary healthcare: a qualitative study","volume":"20","author":"Tzartzas","year":"2019","journal-title":"BMC Fam Pract"},{"key":"2026032607201891000_16.3.e112777.60","doi-asserted-by":"crossref","DOI":"10.1186\/s12873-017-0129-2","article-title":"Reasons for encounter by different levels of urgency in out-of-hours emergency primary health care in Norway: a cross sectional study","volume":"17","author":"Raknes","year":"2017","journal-title":"BMC Emerg Med"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-112777","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T14:20:44Z","timestamp":1774534844000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-112777"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":60,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,26]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1136\/bmjopen-2025-112777"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-112777","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]}}}