Cochrane Effective Practice and Organisation of Care Group, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Box 711, Ottawa, Ontario K1H 8M5, Canada.
Syst Rev. 2013 May 7;2:26. doi: 10.1186/2046-4053-2-26.
Ensuring high quality care for persons with diabetes remains a challenge for healthcare systems globally with consistent evidence of suboptimal care and outcomes. There is increasing interest in quality improvement strategies to improve diabetes management as reflected by a growing number of systematic reviews. These reviews are of varying quality and dispersed across many sources. In this paper, we present an overview of systematic reviews evaluating the impact of interventions to improve the quality of diabetes care.
We searched for systematic reviews evaluating the effectiveness of any intervention intended to improve intermediate patient outcomes and process of care measures for patients with any type of diabetes. Two reviewers independently screened search results, appraised each systematic review using AMSTAR and extracted data from high quality reviews (AMSTAR score ≥ 5). Within reviews, we used vote counting by direction of effect to report the number of studies favouring an intervention for each outcome. We produced summaries of results for each intervention category.
We identified 125 reviews of varying methodological quality and summarised key findings from 50 high quality reviews. We categorised reviews by quality improvement intervention. Eight reviews were broad based (involving a variety of strategies). Other reviews considered: patient education and support (n = 21), telemedicine (n = 10), provider role changes (n = 7), and organisational changes (n = 4). Reviews reported intermediate patient outcomes (e.g. glycaemic control) (n = 49) and process of care outcomes (n = 9). There was evidence of considerable overlap of included studies between reviews.
There is consistent evidence from high quality systematic reviews that patient education and support, provider role changes, and telemedicine are associated with improvements in glycaemic and vascular risk factor control in patients. There is less evidence about the impact of quality improvement interventions on other key process measures such as screening patients for diabetic complications. This paper provides decision makers with a comprehensive overview of evidence from high quality systematic reviews about the effects of quality improvement interventions on improving diabetes care.
确保全球医疗体系中糖尿病患者得到高质量的护理仍然是一个挑战，持续存在护理和结果不理想的证据。越来越多的人对质量改进策略感兴趣，以改善糖尿病管理，这反映在越来越多的系统评价中。这些综述质量参差不齐，分散在许多来源中。在本文中，我们概述了评估旨在改善糖尿病护理质量的干预措施效果的系统评价。
我们搜索了评估任何旨在改善任何类型糖尿病患者中间接患者结局和护理过程措施的干预措施效果的系统评价。两名审查员独立筛选搜索结果，使用 AMSTAR 对每项系统评价进行评估，并从高质量评价（AMSTAR 评分≥5）中提取数据。在评价中，我们使用效果方向的投票计数报告每个结局中支持干预的研究数量。我们对每个干预类别汇总了结果。
我们确定了 125 篇不同方法学质量的评价，并从 50 篇高质量评价中总结了关键发现。我们按质量改进干预措施对评价进行分类。有 8 篇评价是广泛的（涉及各种策略）。其他评价考虑了：患者教育和支持（n=21）、远程医疗（n=10）、提供者角色变化（n=7）和组织变化（n=4）。评价报告了中间患者结局（例如血糖控制）（n=49）和护理过程结局（n=9）。评价之间纳入的研究存在很大程度的重叠。
高质量系统评价的一致证据表明，患者教育和支持、提供者角色变化和远程医疗与改善患者的血糖和血管风险因素控制相关。关于质量改进干预对其他关键过程措施（如筛查糖尿病患者并发症）的影响的证据较少。本文为决策者提供了高质量系统评价关于质量改进干预对改善糖尿病护理效果的证据的全面概述。
