International Centre for Allied Health Evidence, University of South Australia, North Terrace, Adelaide, SA, Australia.
Int J Stroke. 2010 Dec;5(6):466-76. doi: 10.1111/j.1747-4949.2010.00488.x.
Adherence to recommended clinical practices improves stroke outcomes. As a result, stroke clinicians are increasingly expected to evaluate the quality of the care they provide so that areas for improvement can be targeted. Finding the best method to evaluate the quality of dysphagia management can be challenging.
To systematically review process indicators used to assess the quality of care provided to patients with dysphagia following acute stroke and examine the level of evidence underpinning these indicators.
Databases were systematically searched to identify publications (January 2006-April 2009) that describe process indicators relating to the clinical management of acute stroke-related dysphagia. Relevant process indicators were extracted from the reviewed publications for detailed post hoc analysis including supporting evidence and alignment to the current Australian and English stroke guidelines.
Title and abstract review found 150 potential studies. Full-text review resulted in 25 publications that met the study's inclusion criteria. Thirteen process indicators were identified in the literature that related to the initial assessment, clinical management, rehabilitation and discharge planning for patients with acute stroke-related dysphagia. These processes were supported by levels of evidence ranging from high 'level 1' (8%) down to 'expert opinion' evidence (46%). Two process indicators did not align to recommendations in the clinical guidelines. This systematic review underpins informed selection of process indicators for evaluating the quality of dysphagia management following stroke. The selection of quality indicators is complicated by equivocal supporting evidence; however, indicators should reflect expected local practices, align with national stroke guidelines and be feasible for clinical auditing.
系统地回顾用于评估急性卒中后吞咽障碍患者护理质量的过程指标，并考察这些指标的证据水平。
系统检索数据库，以确定描述与急性卒中相关性吞咽障碍的临床管理相关的过程指标的出版物（2006 年 1 月至 2009 年 4 月）。从已回顾的文献中提取相关的过程指标，以便进行详细的事后分析，包括支持证据和与当前澳大利亚和英国卒中指南的一致性。
标题和摘要回顾发现了 150 项潜在的研究。全文回顾纳入了 25 篇符合研究纳入标准的出版物。文献中确定了 13 个与急性卒中相关性吞咽障碍患者的初始评估、临床管理、康复和出院计划相关的过程指标。这些过程的证据水平从高（8%）到“专家意见”（46%）不等。有 2 个过程指标与临床指南的推荐不一致。本系统综述为评估卒中后吞咽障碍管理的质量选择过程指标提供了信息支持。由于支持证据不明确，质量指标的选择较为复杂；然而，指标应反映预期的当地实践，与国家卒中指南一致，并可用于临床审核。
