Department of Health Studies and Gerontology, University of Waterloo, Waterloo, ON, Canada.
Health Soc Care Community. 2012 Mar;20(2):113-27. doi: 10.1111/j.1365-2524.2011.01032.x. Epub 2011 Oct 13.
Transitions between various healthcare services are potential points for fragmented care and can be confusing and complicated for patients, formal and informal caregivers. These challenges are compounded for older adults with chronic disease, as they receive care from many providers in multiple care settings. System navigation has been suggested as an innovative strategy to address these challenges. While a number of navigation models have been developed, there is a lack of consensus on the desired characteristics and effectiveness of this role. We conducted a systematic literature review to describe existing navigator models relevant to chronic disease management for older adults and to investigate the potential impact of each model. Relevant literature was identified using five electronic databases - Medline, CINAHL, the Cochrane database, Embase and PsycINFO between January 1999 and April 2011. Following a recommended process for health services research literature reviews, exclusion and inclusion criteria were applied to retrieved articles; 15 articles documenting nine discrete studies were selected. This review suggests that the role of a navigator for the chronically ill older person is a relatively new one. It provides some evidence that integrated and coordinated care guided by a navigator, using a variety of interventions such as care plans and treatment goals, is beneficial for chronically ill older adults transitioning across care settings. There is a need to further clarify and standardise the definition of navigation, as well as a need for additional research to assess the effectiveness and cost of different approaches to the health system.
在各种医疗保健服务之间的过渡是碎片化护理的潜在点，并且可能使患者、正式和非正式护理者感到困惑和复杂。这些挑战对于患有慢性疾病的老年人来说更为复杂，因为他们需要从多个护理场所的多个提供者那里接受护理。系统导航被认为是解决这些挑战的一种创新策略。虽然已经开发了许多导航模型，但对于该角色的期望特征和有效性缺乏共识。我们进行了系统的文献回顾，以描述与老年人慢性疾病管理相关的现有导航器模型，并研究每个模型的潜在影响。使用 Medline、CINAHL、Cochrane 数据库、Embase 和 PsycINFO 这五个电子数据库，从 1999 年 1 月到 2011 年 4 月，检索了相关文献。根据健康服务研究文献综述的推荐过程，对检索到的文章应用了排除和纳入标准；选择了 15 篇记录了 9 项离散研究的文章。这项综述表明，为慢性病老年人提供导航的角色是相对较新的。它提供了一些证据，表明由导航器指导的整合和协调护理，使用各种干预措施，如护理计划和治疗目标，对于在护理环境之间过渡的慢性病老年人是有益的。需要进一步澄清和规范导航的定义，还需要进一步研究来评估不同方法对卫生系统的有效性和成本。
