Majka Andrew J, Wang Zhen, Schmitz Kristine R, Niesen Cynthia R, Larsen Ruth A, Kinsey Gail C, Murad Angela L, Prokop Larry J, Murad M Hassan
Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
JPEN J Parenter Enteral Nutr. 2014 Jan;38(1):40-52. doi: 10.1177/0148607113482000. Epub 2013 Mar 25.
A systematic review and meta-analysis was completed to summarize care delivery models that used care coordination and/or team approach methods in the management of patients requiring long-term enteral tube feeding. Our aim was to evaluate team composition, implementation strategies, and the effectiveness of these methods.
We conducted a broad search of 7 databases from inception to May 2012, cross-referenced clinical reviews and medical guidelines, and consulted clinical experts. Independent reviewers screened eligible studies, extracted data, and assessed study quality.
Fifteen studies enrolling 2145 patients were included in this review. The studies described multidisciplinary teams composed of primary care physicians, specialists, nurses, dietitians, and language or speech specialists. Patients and their families/caregivers were also an important part of the care team. The interventions were multifaceted and employed multiple simultaneous strategies that particularly included patient and family education, staff education, and continuous auditing and feedback methods. Meta-analysis suggested no significant reductions in complications (incidence rate ratio [IRR], 0.53; 95% confidence interval [CI], 0.27-1.05), infections (IRR, 0.77; 95% CI, 0.48-1.24), and overall hospital admissions (IRR, 0.36; 95% CI, 0.13-1.00) most likely due to lack of statistical power. We found significant reduction of total hospital costs (estimates in US dollars: -623.08; 95% CI, -745.64 to -500.53; P < .01) after the interventions.
Studies suggested a positive association of care coordination by a multidisciplinary team approach and improved patient outcomes for long-term enteral feeding patients. However, the available evidence does not allow estimating the effectiveness of a particular intervention or team composition.
完成了一项系统评价和荟萃分析，以总结在管理长期需要肠内管饲的患者时采用护理协调和/或团队方法的护理提供模式。我们的目的是评估团队组成、实施策略以及这些方法的有效性。
我们对7个数据库从建库至2012年5月进行了广泛检索，交叉引用临床综述和医学指南，并咨询了临床专家。独立评审员筛选符合条件的研究，提取数据并评估研究质量。
本综述纳入了15项研究，共2145例患者。这些研究描述了由初级保健医生、专科医生、护士、营养师以及语言或言语专家组成的多学科团队。患者及其家庭/护理人员也是护理团队的重要组成部分。干预措施是多方面的，同时采用了多种策略，特别包括患者和家庭教育、工作人员教育以及持续审核和反馈方法。荟萃分析表明，并发症（发生率比[IRR]，0.53；95%置信区间[CI]，0.27 - 1.05）、感染（IRR，0.77；95% CI，0.48 - 1.24）和总体住院率（IRR，0.36；95% CI，0.13 - 1.00）没有显著降低，最可能的原因是缺乏统计学效力。我们发现干预后总住院费用显著降低（以美元计：-623.08；95% CI，-745.64至-500.53；P <.01）。
研究表明，多学科团队方法进行护理协调与长期肠内喂养患者改善的结局呈正相关。然而，现有证据无法估计特定干预措施或团队组成的有效性。
