Roberts Shelley, Chaboyer Wendy, Gonzalez Ruben, Marshall Andrea
NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.
School of Information and Communication Technology, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.
BMC Health Serv Res. 2017 Jun 6;17(1):388. doi: 10.1186/s12913-017-2314-0.
Patient participation in health care is associated with improved outcomes for patients and hospitals. New technologies are creating vast potential for patients to participate in care at the bedside. Several studies have explored patient use, satisfaction and perceptions of health information technology (HIT) interventions in hospital. Understanding what works for whom, under what conditions, is important when considering interventions successfully engaging patients in care. This realist review aimed to determine key features of interventions using bedside technology to engage hospital patients in their care and analyse these in terms of context, mechanisms and outcomes.
A realist review was chosen to explain how and why complex HIT interventions work or fail within certain contexts. The review was guided by Pawson's realist review methodology, involving: clarifying review scope; searching for evidence; data extraction and evidence appraisal; synthesising evidence and drawing conclusions. Author experience and an initial literature scope provided insight and review questions and theories (propositions) around why interventions worked were developed and iteratively refined. A purposive search was conducted to find evidence to support, refute or identify further propositions, which formed an explanatory model. Each study was 'mined' for evidence to further develop the propositions and model.
Interactive learning was the overarching theme of studies using technology to engage patients in their care. Several propositions underpinned this, which were labelled: information sharing; self-assessment and feedback; tailored education; user-centred design; and support in use of HIT. As studies were mostly feasibility or usability studies, they reported patient-centred outcomes including patient acceptability, satisfaction and actual use of HIT interventions. For each proposition, outcomes were proposed to come about by mechanisms including improved communication, shared decision-making, empowerment and self-efficacy; which acted as facilitators to patient participation in care. Overall, there was a stronger representation of health than IT disciplines in studies reviewed, with a lack of IT input in terms of theoretical underpinning, methodological design and reporting of outcomes.
HIT interventions have great potential for engaging hospitalised patients in their care. However, stronger interdisciplinary collaboration between health and IT researchers is needed for effective design and evaluation of HIT interventions.
患者参与医疗保健与患者和医院改善的治疗效果相关。新技术为患者在床边参与护理创造了巨大潜力。多项研究探讨了患者对医院健康信息技术（HIT）干预措施的使用、满意度和看法。在考虑成功促使患者参与护理的干预措施时，了解何种措施对何人、在何种条件下起作用很重要。本实证性综述旨在确定使用床边技术促使住院患者参与护理的干预措施的关键特征，并从背景、机制和结果方面对其进行分析。
选择实证性综述来解释复杂的HIT干预措施在特定背景下如何以及为何有效或无效。该综述以帕森斯的实证性综述方法为指导，包括：明确综述范围；搜索证据；数据提取和证据评估；综合证据并得出结论。作者的经验和初始文献范围提供了见解，并围绕干预措施为何有效制定并反复完善了综述问题和理论（命题）。进行了有目的的搜索以寻找支持、反驳或确定进一步命题的证据，从而形成一个解释模型。对每项研究进行“挖掘”以获取证据，进一步完善命题和模型。
交互式学习是利用技术促使患者参与护理的研究的首要主题。有几个命题支撑这一主题，分别标记为：信息共享；自我评估与反馈；量身定制的教育；以用户为中心的设计；以及对HIT使用的支持。由于研究大多是可行性或可用性研究，它们报告了以患者为中心的结果，包括患者对HIT干预措施的可接受性、满意度和实际使用情况。对于每个命题，结果是通过包括改善沟通、共同决策、赋权和自我效能感等机制实现的；这些机制促进了患者参与护理。总体而言，在所审查的研究中，健康学科的代表性比信息技术学科更强，在理论基础、方法设计和结果报告方面缺乏信息技术方面的投入。
HIT干预措施在促使住院患者参与护理方面具有巨大潜力。然而，健康和信息技术研究人员之间需要更强有力的跨学科合作，以有效设计和评估HIT干预措施。
