Wensing Michel, Wollersheim Hub, Grol Richard
Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Implement Sci. 2006 Feb 22;1:2. doi: 10.1186/1748-5908-1-2.
Changing the organization of patient care should contribute to improved patient outcomes as functioning of clinical teams and organizational structures are important enablers for improvement.
To provide an overview of the research evidence on effects of organizational strategies to implement improvements in patient care.
Structured review of published reviews of rigorous evaluations.
Published reviews of studies on organizational interventions.
Searches were conducted in two data-bases (Pubmed, Cochrane Library) and in selected journals. Reviews were included, if these were based on a systematic search, focused on rigorous evaluations of organizational changes, and were published between 1995 and 2003. Two investigators independently extracted information from the reviews regarding their clinical focus, methodological quality and main quantitative findings.
A total of 36 reviews were included, but not all were high-quality reviews. The reviews were too heterogeneous for quantitative synthesis. None of the strategies produced consistent effects. Professional performance was generally improved by revision of professional roles and computer systems for knowledge management. Patient outcomes was generally improved by multidisciplinary teams, integrated care services, and computer systems. Cost savings were reported from integrated care services. The benefits of quality management remained uncertain.
There is a growing evidence base of rigorous evaluations of organizational strategies, but the evidence underlying some strategies is limited and for no strategy can the effects be predicted with high certainty.
改变患者护理的组织方式应有助于改善患者结局，因为临床团队的运作和组织结构是实现改善的重要推动因素。
概述关于实施患者护理改善的组织策略效果的研究证据。
对已发表的严格评估综述进行结构化审查。
关于组织干预研究的已发表综述。
在两个数据库（PubMed、Cochrane图书馆）和选定期刊中进行检索。如果综述基于系统检索、侧重于对组织变革的严格评估且发表于1995年至2003年之间，则纳入综述。两名研究人员独立从综述中提取有关其临床重点、方法学质量和主要定量结果的信息。
共纳入36篇综述，但并非所有都是高质量综述。这些综述差异太大，无法进行定量综合分析。没有一种策略产生一致的效果。通过修订专业角色和知识管理计算机系统，专业表现总体上得到改善。通过多学科团队、综合护理服务和计算机系统，患者结局总体上得到改善。综合护理服务报告有成本节约。质量管理的益处仍不确定。
对组织策略进行严格评估的证据基础在不断扩大，但一些策略的证据有限，而且没有一种策略的效果能被高度确定地预测。
