Davidson Patricia M, Newton Phillip J, Tankumpuan Thitipong, Paull G, Dennison-Himmelfarb Cheryl
Johns Hopkins University School of Nursing, Baltimore, Maryland; Faculty of Health, University of Technology, Sydney, Australia.
Faculty of Health, University of Technology, Sydney, Australia.
Clin Ther. 2015 Oct 1;37(10):2225-33. doi: 10.1016/j.clinthera.2015.08.021. Epub 2015 Sep 26.
Globally, the management of chronic heart failure (CHF) challenges health systems. The high burden of disease and the costs associated with hospitalization adversely affect individuals, families, and society. Improved quality, access, efficiency, and equity of CHF care can be achieved by using multidisciplinary care approaches if there is adherence and fidelity to the program's elements. The goal of this article was to summarize evidence and make recommendations for advancing practice, education, research, and policy in the multidisciplinary management of patients with CHF.
Essential elements of multidisciplinary management of CHF were identified from meta-analyses and clinical practice guidelines. The study factors were discussed from the perspective of the health care system, providers, patients, and their caregivers. Identified gaps in evidence were used to identify areas for future focus in CHF multidisciplinary management.
Although there is high-level evidence (including several meta-analyses) for the efficacy of management programs for CHF, less evidence exists to determine the benefit attributable to individual program components or to identify the specific content of effective components and the manner of their delivery. Health care system, provider, and patient factors influence health care models and the effective management of CHF and require focus and attention.
Extrapolating trial findings to clinical practice settings is limited by the heterogeneity of study populations and the implementation of models of intervention beyond academic health centers, where practice environments differ considerably. Ensuring that individual programs are both developed and assessed that consider these factors is integral to ensuring adherence and fidelity with the core dimensions of disease management necessary to optimize patient and organizational outcomes. Recognizing the complexity of the multidisciplinary CHF interventions will be important in advancing the design, implementation, and evaluation of the interventions.
在全球范围内，慢性心力衰竭（CHF）的管理对卫生系统构成挑战。疾病的高负担以及与住院相关的费用对个人、家庭和社会产生不利影响。如果能坚持并忠实执行项目要素，采用多学科护理方法可提高CHF护理的质量、可及性、效率和公平性。本文的目的是总结证据，并就推进CHF患者多学科管理的实践、教育、研究和政策提出建议。
从荟萃分析和临床实践指南中确定CHF多学科管理的基本要素。从卫生保健系统、提供者、患者及其护理人员的角度讨论研究因素。利用已确定的证据空白来确定CHF多学科管理未来重点关注的领域。
尽管有高级别证据（包括多项荟萃分析）证明CHF管理项目的有效性，但确定单个项目组成部分的益处、确定有效组成部分的具体内容及其提供方式的证据较少。卫生保健系统、提供者和患者因素会影响卫生保健模式以及CHF的有效管理，需要予以关注。
将试验结果外推至临床实践环境受到研究人群异质性以及学术健康中心以外干预模式实施情况的限制，因为学术健康中心以外的实践环境差异很大。确保制定并评估考虑这些因素的单个项目对于确保坚持并忠实执行优化患者和组织结局所需的疾病管理核心维度至关重要。认识到多学科CHF干预措施的复杂性对于推进干预措施的设计、实施和评估至关重要。
