Chen Yen-Fu, Boyal Amunpreet, Sutton Elizabeth, Armoiry Xavier, Watson Samuel, Bion Julian, Tarrant Carolyn
Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
Warwick Centre for Applied Health Research & Delivery, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
Syst Rev. 2016 May 21;5:84. doi: 10.1186/s13643-016-0260-2.
Growing literature has demonstrated that patients admitted to hospital during weekends tend to have less favourable outcomes, including increased mortality, compared with similar patients admitted during weekdays. Major policy interventions such as the 7-day services programme in the UK NHS have been initiated to reduce this weekend effect, although the mechanisms behind the effect are unclear. Here, we propose a mixed methods review to systematically examine the literature surrounding the magnitude and mechanisms of the weekend effect.
MEDLINE, CINAHL, HMIC, EMBASE, EthOS, CPCI and the Cochrane Library were searched from Jan 2000 to April 2015 using terms related to 'weekends or out-of-hours' and 'hospital admissions'. The 5404 retrieved records were screened by the review team, and will feed into two component reviews: a systematic review of the magnitude of the weekend effect and a framework synthesis of the mechanisms of the weekend effect. A repeat search of MEDLINE will be conducted mid-2016 to update both component reviews. The systematic review will include quantitative studies of non-specific hospital admissions. The primary outcome is the weekend effect on mortality, which will be estimated using a Bayesian random effects meta-analysis. Weekend effects on adverse events, length of hospital stay and patient experience will also be examined. The development of the framework synthesis has been informed by the initial scoping of the literature and focus group discussions. The synthesis will examine both quantitative and qualitative studies that have compared the processes and quality of care between weekends and weekdays, and explicate the underlying mechanisms of the weekend effect.
The weekend effect is a complex phenomenon that has major implications for the organisation of health services. Its magnitude and underlying mechanisms have been subject to heated debate. Published literature reviews have adopted restricted scopes or methods and mainly focused on quantitative evidence. This proposed review intends to provide a comprehensive and in-depth synthesis of diverse evidence to inform future policy and research aiming to address the weekend effect.
PROSPERO 2016: CRD42016036487.
越来越多的文献表明，与工作日入院的类似患者相比，周末入院的患者往往预后较差，包括死亡率增加。尽管这种效应背后的机制尚不清楚，但英国国民健康服务体系（NHS）的7天服务计划等重大政策干预措施已被启动，以减少这种周末效应。在此，我们提出一项混合方法综述，以系统地研究围绕周末效应的程度和机制的文献。
使用与“周末或非工作时间”和“住院”相关的术语，在2000年1月至2015年4月期间对MEDLINE、CINAHL、HMIC、EMBASE、EthOS、CPCI和Cochrane图书馆进行检索。检索到的5404条记录由综述团队进行筛选，并将纳入两个部分综述：周末效应程度的系统综述和周末效应机制的框架综合分析。2016年年中将对MEDLINE进行重复检索，以更新两个部分综述。系统综述将包括对非特定住院患者的定量研究。主要结局是周末对死亡率的影响，将使用贝叶斯随机效应荟萃分析进行估计。还将研究周末对不良事件、住院时间和患者体验的影响。框架综合分析的开展已参考了文献的初步范围界定和焦点小组讨论。该综合分析将研究比较周末和工作日护理过程及质量的定量和定性研究，并阐明周末效应的潜在机制。
周末效应是一种复杂的现象，对卫生服务的组织具有重大影响。其程度和潜在机制一直是激烈辩论的主题。已发表的文献综述采用的范围或方法有限，主要侧重于定量证据。本拟进行的综述旨在对各种证据进行全面深入的综合分析，为未来旨在解决周末效应的政策和研究提供参考。
PROSPERO 2016：CRD42016036487
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