Donald Faith, Kilpatrick Kelley, Reid Kim, Carter Nancy, Martin-Misener Ruth, Bryant-Lukosius Denise, Harbman Patricia, Kaasalainen Sharon, Marshall Deborah A, Charbonneau-Smith Renee, Donald Erin E, Lloyd Monique, Wickson-Griffiths Abigail, Yost Jennifer, Baxter Pamela, Sangster-Gormley Esther, Hubley Pamela, Laflamme Célyne, Campbell-Yeo Marsha, Price Sheri, Boyko Jennifer, DiCenso Alba
Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, Canada M5B 2K3.
Faculty of Nursing, Université de Montreal and Research Centre of Hôpital Maisonneuve-Rosemont, CSA-RC-Aile Bleue-Room F121, 5415 boulevard l'Assomption, Montréal, QC, Canada H1T 2M4.
Nurs Res Pract. 2014;2014:896587. doi: 10.1155/2014/896587. Epub 2014 Sep 1.
Background. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP) and clinical nurse specialist (CNS) roles. Objective. To assess the quality of randomized controlled trials (RCTs) evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization). Design. Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012. Results. 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient (n = 11), NP-transition (n = 5), NP-inpatient (n = 2), CNS-outpatient (n = 11), CNS-transition (n = 13), and CNS-inpatient (n = 1). Internal validity was assessed using the Cochrane risk of bias tool; 18 (42%) studies were at low, 17 (39%) were at moderate, and eight (19%) at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity. Conclusions. We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles.
背景。提高医疗质量和控制医疗成本是影响实施执业护士（NP）和临床护理专家（CNS）角色决策的重要因素。目的。评估评价NP和CNS成本效益（广义定义还包括衡量卫生资源利用的研究）的随机对照试验（RCT）的质量。设计。对1980年至2012年7月期间报告的NP和CNS成本效益的RCT进行系统评价。结果。共检索到4397条独特记录。我们纳入了43项RCT，分为六个类别，NP门诊（n = 11），NP过渡期（n = 5），NP住院期（n = 2），CNS门诊（n = 11），CNS过渡期（n = 13）和CNS住院期（n = 1）。使用Cochrane偏倚风险工具评估内部效度；18项（42%）研究偏倚风险低，17项（39%）为中度，8项（19%）为高偏倚风险。很少有研究详细描述NP或CNS的教育、经验或角色，影响了外部效度。结论。我们确定了43项使用符合当前角色定义标准的评价NP和CNS成本效益的RCT。几乎一半的RCT偏倚风险低。研究方法报告不完整以及缺乏关于NP或CNS教育、经验和角色的详细信息，给整合这些角色成本效益的证据带来了挑战。
