Diehl Heinz, Graverholt Birgitte, Espehaug Birgitte, Lund Hans
Centre for Evidence-Based Practice, Bergen University College, Inndalsveien 58, 5063, Bergen, Norway.
Department of Sports Science and Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
BMC Health Serv Res. 2016 Jul 25;16:298. doi: 10.1186/s12913-016-1550-z.
Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects of interventions to improve the implementation of guidelines in nursing homes.
A systematic literature search was conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, DARE, HTA, CENTRAL, SveMed + and ISI Web of Science from their inception until August 2015. Reference screening and a citation search were performed. Studies were eligible if they evaluated any type of guideline implementation strategy in a nursing home setting. Eligible study designs were systematic reviews, randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted-time-series studies. The EPOC risk of bias tool was used to evaluate the risk of bias in the included studies. The overall quality of the evidence was rated using GRADE.
Five cluster-randomised controlled trials met the inclusion criteria, evaluating a total of six different multifaceted implementation strategies. One study reported a small statistically significant effect on professional practice, and two studies demonstrated small to moderate statistically significant effects on patient outcome. The overall quality of the evidence for all comparisons was low or very low using GRADE.
Little is known about how to improve the implementation of guidelines in nursing homes, and the evidence to support or discourage particular interventions is inconclusive. More implementation research is needed to ensure high quality of care in nursing homes.
PROSPERO 2014: CRD42014007664.
关于指南实施策略的研究大多是在与疗养院环境差异显著的环境中进行的，因此其向疗养院环境的可转移性有限。本研究的目的是系统评价改善疗养院指南实施的干预措施的效果。
从创刊至2015年8月，在Cochrane图书馆、CINAHL、Embase、MEDLINE、DARE、HTA、CENTRAL、SveMed+和ISI Web of Science中进行系统的文献检索。进行了参考文献筛选和引文检索。如果研究评估了疗养院环境中任何类型的指南实施策略，则该研究符合条件。符合条件的研究设计包括系统评价、随机对照试验、非随机对照试验、前后对照研究和中断时间序列研究。使用EPOC偏倚风险工具评估纳入研究中的偏倚风险。使用GRADE对证据的总体质量进行评级。
五项整群随机对照试验符合纳入标准，共评估了六种不同的多方面实施策略。一项研究报告了对专业实践有统计学意义的小效应，两项研究表明对患者结局有小至中等统计学意义的效应。使用GRADE，所有比较的证据总体质量低或非常低。
关于如何改善疗养院指南的实施知之甚少，支持或不支持特定干预措施的证据尚无定论。需要更多的实施研究来确保疗养院的高质量护理。
PROSPERO 2014：CRD42014007664。
