Newton Phillip J, Davidson Patricia M, Halcomb Elizabeth J, Denniss A Robert, Westgarth Fidye
School of Nursing, Family and Community Health, College of Social and Health Science, University of Western Sydney, West Area Health Service, New South Wales, Australia.
J Cardiovasc Nurs. 2006 May-Jun;21(3):161-8. doi: 10.1097/00005082-200605000-00002.
Heart failure (HF) is responsible for significant disease burden in developed countries internationally. Despite significant advances and a strong evidence base in therapies and treatment strategies for HF, access to these therapies continues to remain elusive to a significant proportion of the HF population. The reasons for this are multifactorial and range from the financial cost of treatments to the individual attitudes and beliefs of clinicians. The collaborative methodology, based upon a quality improvement philosophy, has been identified as a potentially useful tool to address this treatment gap.
In this manuscript, we review the published literature on the collaborative methodology and assess the evidence for achieving improvement in the management of HF.
Searches of electronic databases, the reference lists of published materials, policy documents, and the Internet were conducted using key words including "collaborative methodology," "breakthrough series," "quality improvement," "total quality improvement," and "heart failure." Because of the paucity of high-level evidence, all English-language articles were included in the review.
On the basis of the identified search strategy, 43 articles were retrieved. Key themes that emerged from the literature included the following: (1) The collaborative methodology has a significant potential to reduce the treatment gap. (2) Leadership is an important characteristic of the collaborative method. (3) The collaborative methodology facilitates sustainability of the quality improvement process.
The collaborative methodology, when implemented and conducted according to key conceptual principles, has significant potential to improve the outcomes of patients, particularly those with HF and chronic cardiovascular disease.
在国际上的发达国家，心力衰竭（HF）造成了巨大的疾病负担。尽管在HF的治疗方法和治疗策略方面取得了重大进展且有强有力的证据基础，但很大一部分HF患者仍难以获得这些治疗。其原因是多方面的，从治疗的经济成本到临床医生的个人态度和信念。基于质量改进理念的协作方法已被确定为解决这一治疗差距的潜在有用工具。
在本手稿中，我们回顾了关于协作方法的已发表文献，并评估在HF管理方面实现改善的证据。
使用包括“协作方法”“突破系列”“质量改进”“全面质量改进”和“心力衰竭”等关键词，对电子数据库、已发表材料的参考文献列表、政策文件和互联网进行检索。由于高水平证据匮乏，所有英文文章均纳入本综述。
基于确定的检索策略，检索到43篇文章。文献中出现的关键主题包括：（1）协作方法有显著潜力缩小治疗差距；（2）领导力是协作方法的一个重要特征；（3）协作方法促进质量改进过程的可持续性。
按照关键概念原则实施和开展协作方法时，有显著潜力改善患者结局，尤其是HF和慢性心血管疾病患者的结局。
