Franx Gerdien, Kroon Hans, Grimshaw Jeremy, Drake Robert, Grol Richard, Wensing Michel
Department of Innovation of Mental Health Care, Trimbos-instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands]
Can J Psychiatry. 2008 May;53(5):294-305. doi: 10.1177/070674370805300503.
To provide a comprehensive overview of the research on organizational changes aimed at improving health care for patients with severe mental illness and to learn lessons for mental health practice from the results.
We searched for systematic literature reviews published in English during 2000 to 2007 in PubMed, PsycINFO, CINAHL, EMBASE, and the Cochrane Central Register of Systematic Reviews. Three reviewers independently selected and assessed the studies' quality. Studies involving changes of who delivers health care, how care is organized, or where care is delivered were included. We categorized the studies using an existing taxonomy of 6 broad categories of strategies for organizational change.
A total of 21 reviews were included. Among these, 17 had reasonably good methodological quality, Almost all reviews included or intended to include randomized controlled trials (RCTs), 6 reviews did not identify studies that met eligibility criteria. Multidisciplinary teams and integrated care models had been reviewed most frequently (a total of 15 reviews). In most studies, these types of changes showed better outcomes in terms of symptom severity, functioning, employment, and housing, compared with conventional services. Different results were found on cost savings. Other types of organizational changes, such as changing professional roles or introducing quality management or knowledge management, were much less frequently reviewed. Very few reviews looked at effects of organizational changes on professional performance.
There is a fairly large body of evidence of the positive impact of multidisciplinary teams and integrated care changes on symptom severity, functioning, employment, and housing of people with severe mental illness, compared with conventional services. Other strategies, such as changes in professional roles, quality or knowledge management, have either not been the subject of systematic reviews or have not been evaluated in RCTs. There is still a lack of insight in the so-called black box of change processes and the impact of change on professional performance.
全面概述旨在改善重症精神疾病患者医疗保健的组织变革研究，并从研究结果中汲取心理健康实践的经验教训。
我们检索了2000年至2007年期间在PubMed、PsycINFO、CINAHL、EMBASE和Cochrane系统评价中央登记库中发表的英文系统文献综述。三位评审员独立选择并评估研究质量。纳入涉及医疗保健提供者、护理组织方式或护理地点变更的研究。我们使用现有的组织变革六大类策略分类法对研究进行分类。
共纳入21篇综述。其中，17篇方法学质量较好。几乎所有综述都纳入或打算纳入随机对照试验（RCT），6篇综述未找到符合纳入标准的研究。多学科团队和综合护理模式的综述最为频繁（共15篇）。在大多数研究中，与传统服务相比，这些类型的变革在症状严重程度、功能、就业和住房方面显示出更好的结果。在成本节约方面发现了不同的结果。其他类型的组织变革，如改变专业角色或引入质量管理或知识管理，受到的综述要少得多。很少有综述关注组织变革对专业绩效的影响。
与传统服务相比，有相当多的证据表明多学科团队和综合护理变革对重症精神疾病患者的症状严重程度、功能、就业和住房有积极影响。其他策略，如专业角色的改变、质量或知识管理，要么尚未成为系统综述的主题，要么尚未在随机对照试验中进行评估。对于变革过程的所谓“黑箱”以及变革对专业绩效的影响，仍然缺乏深入了解。
