Breneol Sydney, Belliveau Julia, Cassidy Christine, Curran Janet A
School of Nursing, Dalhousie University, Canada.
Dalhousie University, Canada.
Int J Nurs Stud. 2017 Jul;72:91-104. doi: 10.1016/j.ijnurstu.2017.04.011. Epub 2017 May 4.
Children with medical complexity constitute a small but resource-intensive subgroup of children with special health care needs. Their medical fragility and resource-intensive needs put them at greater risk for inadequate transitions from hospital to home-based care, and subsequent adverse outcomes and hospital re-admissions.
This scoping literature review was conducted to map empirically researched interventions, frameworks, programs or models that could inform or support the transition from hospital to home for children with medical complexity.
We conducted a scoping review using the methodology outlined by the Joanna Briggs Institute.
In consultation with an experienced librarian, we searched PubMed, EMBASE and CINAHL for English-language articles published from the date of origin to February 2016. We also hand-searched four high impact journals and searched the reference lists of relevant articles.
Two reviewers independently screened the literature results according to inclusion criteria. Empirically designed studies that targeted children <18years old who were specifically defined as medically complex or fragile and transitioning from acute care to home were included. Data were extracted using a predefined tool. Quality appraisal of the articles was conducted using the mixed methods appraisal tool (MMAT). Thematic analysis was carried out to identify existing patterns or trends in the included studies.
Of the 2088 abstracts retrieved, 14 studies met the inclusion criteria. Following analysis, we identified three major categories of interventions: Comprehensive care plans (n=3), Complex Care Programs (n=8) and Integrated delivery models (n=3). The overall quality of included studies was moderate, with 21% (n=3) scoring 0.25, 29% (n=4) scoring 0.50, 43% (n=6) scoring 0.75, and 7% (n=1) scoring 1.0.
In the absence of evidence-based guidelines to ensure adequate transitions from hospital to home for children with medical complexity, identification of potential models to support this transition is imperative. We identified interventions, frameworks, models and programs in the literature that might inform the development of such guidelines; however, there is a need for consensus around the definition for children with medical complexity and the limited number of these studies and lack of high quality of evidence signals the need for further research to improve the transition from hospital to home and ultimately, improve patient and family outcomes.
患有复杂疾病的儿童是有特殊医疗保健需求儿童中的一个小群体，但资源需求大。他们的医疗脆弱性和对资源的大量需求使他们在从医院过渡到家庭护理时面临更大风险，进而导致不良后果和再次入院。
进行这项范围综述，以梳理出经实证研究的干预措施、框架、项目或模型，为患有复杂疾病的儿童从医院过渡到家庭提供参考或支持。
我们采用乔安娜·布里格斯研究所概述的方法进行范围综述。
在与一位经验丰富的图书馆员协商后，我们在PubMed、EMBASE和CINAHL数据库中检索了从创刊日期至2016年2月发表的英文文章。我们还手工检索了四种高影响力期刊，并检索了相关文章的参考文献列表。
两名评审员根据纳入标准独立筛选文献结果。纳入的是针对年龄小于18岁、被明确界定为患有复杂疾病或身体脆弱且正从急性护理过渡到家庭护理的儿童的实证研究。使用预定义工具提取数据。使用混合方法评估工具（MMAT）对文章进行质量评估。进行主题分析以确定纳入研究中现有的模式或趋势。
在检索到的2088篇摘要中，有14项研究符合纳入标准。经过分析，我们确定了三大类干预措施：综合护理计划（3项）、复杂护理项目（8项）和综合服务模式（3项）。纳入研究的总体质量中等，21%（3项）得分为0.25，29%（4项）得分为0.50，43%（6项）得分为0.75，7%（1项）得分为1.0。
由于缺乏基于证据的指南来确保患有复杂疾病的儿童从医院到家庭的充分过渡，因此必须确定支持这种过渡的潜在模式。我们在文献中确定了可能为制定此类指南提供参考的干预措施、框架、模式和项目；然而，对于患有复杂疾病儿童的定义需要达成共识，而且这些研究数量有限且证据质量不高，这表明需要进一步研究以改善从医院到家庭的过渡，并最终改善患者和家庭的结局。
