Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
BMC Health Serv Res. 2012 Aug 24;12:275. doi: 10.1186/1472-6963-12-275.
Against a backdrop of rising healthcare costs, variability in care provision and an increased emphasis on patient satisfaction, the need for effective interventions to improve quality of care has come to the fore. This is the first ten year (2000-2010) systematic review of interventions which sought to improve quality of care in a hospital setting. This review moves beyond a broad assessment of outcome significance levels and makes recommendations for future effective and accessible interventions.
Two researchers independently screened a total of 13,195 English language articles from the databases PsychInfo, Medline, PubMed, EmBase and CinNahl. There were 120 potentially relevant full text articles examined and 20 of those articles met the inclusion criteria.
Included studies were heterogeneous in terms of approach and scientific rigour and varied in scope from small scale improvements for specific patient groups to large scale quality improvement programmes across multiple settings. Interventions were broadly categorised as either technical (n = 11) or interpersonal (n = 9). Technical interventions were in the main implemented by physicians and concentrated on improving care for patients with heart disease or pneumonia. Interpersonal interventions focused on patient satisfaction and tended to be implemented by nursing staff. Technical interventions had a tendency to achieve more substantial improvements in quality of care.
The rigorous application of inclusion criteria to studies established that despite the very large volume of literature on quality of care improvements, there is a paucity of hospital interventions with a theoretically based design or implementation. The screening process established that intervention studies to date have largely failed to identify their position along the quality of care spectrum. It is suggested that this lack of theoretical grounding may partly explain the minimal transfer of health research to date into policy. It is recommended that future interventions are established within a theoretical framework and that selected quality of care outcomes are assessed using this framework. Future interventions to improve quality of care will be most effective when they use a collaborative approach, involve multidisciplinary teams, utilise available resources, involve physicians and recognise the unique requirements of each patient group.
在医疗保健成本上升、医疗服务提供的可变性以及对患者满意度的重视日益增加的背景下，需要采取有效的干预措施来提高医疗质量。这是首次对旨在改善医院环境下医疗质量的干预措施进行的十年（2000-2010 年）系统评价。本次评价不仅广泛评估了结果的重要性水平，还为未来有效和可及的干预措施提供了建议。
两位研究人员独立筛选了来自 PsychInfo、Medline、PubMed、EmBase 和 CinNahl 数据库的共计 13195 篇英文文章。共检查了 120 篇潜在相关的全文文章，其中 20 篇符合纳入标准。
纳入的研究在方法和科学严谨性方面存在差异，研究范围从针对特定患者群体的小规模改进到跨多个环境的大规模质量改进计划不等。干预措施大致可分为技术干预（n=11）和人际干预（n=9）。技术干预主要由医生实施，主要集中在改善心脏病或肺炎患者的护理。人际干预侧重于患者满意度，主要由护理人员实施。技术干预往往能使医疗质量得到更大的改善。
严格按照纳入标准对研究进行筛选，确定尽管关于医疗质量改进的文献数量非常庞大，但具有理论基础设计或实施的医院干预措施却很少。筛选过程确定，迄今为止，干预研究在很大程度上未能确定其在医疗质量谱中的位置。据推测，这种缺乏理论基础可能部分解释了迄今为止健康研究向政策的转化程度很低。建议未来的干预措施建立在理论框架内，并使用该框架评估选定的医疗质量结果。当未来的干预措施采用协作方法、涉及多学科团队、利用现有资源、涉及医生并认识到每个患者群体的独特需求时，将最有效地提高医疗质量。
