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衡量过渡护理中的“三重目标”:一项系统综述。

Measuring the "triple aim" in transition care: a systematic review.

作者信息

Prior Megan, McManus Margaret, White Patience, Davidson Laurie

机构信息

The National Alliance to Advance Adolescent Health, Washington, District of Columbia; and Georgetown University School of Medicine, Washington District of Columbia

The National Alliance to Advance Adolescent Health, Washington, District of Columbia; and.

出版信息

Pediatrics. 2014 Dec;134(6):e1648-61. doi: 10.1542/peds.2014-1704.

DOI:10.1542/peds.2014-1704
PMID:25422015
Abstract

BACKGROUND AND OBJECTIVES

Without adequate support, adolescents transitioning from the pediatric to the adult health care system are at increased risk for poor health outcomes. Numerous interventions attempt to improve this transition, yet few comprehensively evaluate efficacy. To advance evaluation methods and ultimately the quality of transition services, it is necessary to understand the current state of health care transition measurement. This study examines and categorizes transition measures by using the "Triple Aim" framework of experience of care, population health, and cost of care.

METHODS

Ovid Medline and the Cumulative Index to Nursing and Allied Health Literature were searched for articles published between 1995 and 2013. Two reviewers independently screened studies and included those that evaluated the impact of a health care transition intervention. Measures were subsequently classified according to population health, experience of care, and costs of care.

RESULTS

Of the 2282 studies initially identified, 33 met inclusion criteria. Population health measures were used in 27 studies, with disease-specific measures collected most frequently. Fifteen studies measured cost, most often service utilization. Eight studies measured experience of care, with satisfaction assessed most commonly. Only 3 studies examined all 3 domains of the "Triple Aim." Transition interventions described in the gray literature were not reviewed.

CONCLUSIONS

Transition programs are inconsistently evaluated in terms of their impact on population health, patient experience, and cost. To demonstrate improvement in the transition from pediatric to adult health care, a more robust and consistent set of measures is needed.

摘要

背景与目的

在缺乏充分支持的情况下,从儿科医疗体系过渡到成人医疗体系的青少年面临健康状况不佳的风险增加。众多干预措施试图改善这种过渡情况,但很少有对疗效进行全面评估的。为了改进评估方法并最终提高过渡服务质量,有必要了解医疗过渡测量的当前状况。本研究使用“三重目标”框架(医疗体验、人群健康和医疗成本)对过渡测量进行检查和分类。

方法

检索Ovid Medline和护理及联合健康文献累积索引中1995年至2013年发表的文章。两名评审员独立筛选研究,纳入那些评估医疗过渡干预影响的研究。随后根据人群健康、医疗体验和医疗成本对测量指标进行分类。

结果

在最初识别的2282项研究中,33项符合纳入标准。27项研究使用了人群健康测量指标,其中最常收集的是特定疾病指标。15项研究测量了成本,最常见的是服务利用率。8项研究测量了医疗体验,最常评估的是满意度。只有3项研究考察了“三重目标”的所有三个领域。未对灰色文献中描述的过渡干预措施进行综述。

结论

过渡项目在对人群健康、患者体验和成本的影响方面评估不一致。为了证明从儿科到成人医疗过渡的改善,需要一套更强大、更一致的测量指标。

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