Okrainec Karen, Lau Davina, Abrams Howard B, Hahn-Goldberg Shoshanna, Brahmbhatt Ronak, Huynh Tai, Lam Kenneth, Bell Chaim M
University Health Network, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Ontario, Canada.
J Hosp Med. 2017 Feb;12(2):110-117. doi: 10.12788/jhm.2692.
Patient-centered discharge tools provide an opportunity to engage patients, enhance patient understanding, and improve capacity for self-care and postdischarge outcomes.
To review studies that engaged patients in the design or delivery of discharge instruction tools and that tested their effect among hospitalized patients.
We conducted a search of 12 databases and journals from January 1994 through May 2014, and references of retrieved studies.
English-language studies that tested discharge tools meant to engage patients were selected. Studies that measured outcomes after 3 months or without a control group or period were excluded.
Two independent reviewers assessed the full-text papers and extracted data on features of patient engagement.
Thirty articles met inclusion criteria, 28 of which examined educational tools. Of these, 13 articles involved patients in content creation or tool delivery, with only 6 studies involving patients in both. While many of these studies (10 studies) demonstrated an improvement in patient comprehension, few studies found improvement in patient adherence despite their engagement. A few studies demonstrated an improvement in self-efficacy (2 studies) and a reduction in unplanned visits (3 studies).
Improving patient engagement through the use of media, visual aids, or by involving patients when creating or delivering a discharge tool improves comprehension. However, further studies are needed to clarify the effect on patient experience, adherence, and healthcare utilization postdischarge. Better characterization of the level of patient engagement when designing discharge tools is needed given the heterogeneity found in current studies. Journal of Hospital Medicine 2017;12:110-117.
以患者为中心的出院工具为患者参与、增强患者理解以及提高自我护理能力和出院后结局提供了契机。
回顾让患者参与出院指导工具设计或交付并在住院患者中测试其效果的研究。
我们检索了1994年1月至2014年5月期间的12个数据库和期刊以及检索到的研究的参考文献。
选取测试旨在让患者参与的出院工具的英文研究。排除测量3个月后结局或无对照组或对照期的研究。
两名独立评审员评估全文论文并提取关于患者参与特征的数据。
30篇文章符合纳入标准，其中28篇研究了教育工具。其中，13篇文章让患者参与内容创建或工具交付，只有6项研究让患者同时参与这两方面。虽然这些研究中的许多（10项研究）表明患者理解有所改善，但很少有研究发现尽管患者参与了，其依从性有所改善。少数研究表明自我效能有所提高（2项研究），计划外就诊有所减少（3项研究）。
通过使用媒体、视觉辅助工具或在创建或交付出院工具时让患者参与来提高患者参与度可改善理解。然而，需要进一步研究以阐明对患者体验、依从性和出院后医疗保健利用的影响。鉴于当前研究中发现的异质性，在设计出院工具时需要更好地描述患者参与水平。《医院医学杂志》2017年；12:110 - 117。
