Kronenberg Christoph, Doran Tim, Goddard Maria, Kendrick Tony, Gilbody Simon, Dare Ceri R, Aylott Lauren, Jacobs Rowena
National Research Center for Health Economics, University of Duisburg-Essen, Essen, Germany.
Department of Health Sciences.
Br J Gen Pract. 2017 Aug;67(661):e519-e530. doi: 10.3399/bjgp17X691721. Epub 2017 Jul 3.
Serious mental illness (SMI) - which comprises long-term conditions such as schizophrenia, bipolar disorder, and other psychoses - has enormous costs for patients and society. In many countries, people with SMI are treated solely in primary care, and have particular needs for physical care.
The objective of this study was to systematically review the literature to create a list of quality indicators relevant to patients with SMI that could be captured using routine data, and which could be used to monitor or incentivise better-quality primary care.
A systematic literature review, combined with a search of quality indicator databases and guidelines.
The authors assessed whether indicators could be measured from routine data and the quality of the evidence.
Out of 1847 papers and quality indicator databases identified, 27 were included, from which 59 quality indicators were identified, covering six domains. Of the 59 indicators, 52 could be assessed using routine data. The evidence base underpinning these indicators was relatively weak, and was primarily based on expert opinion rather than trial evidence.
With appropriate adaptation for different contexts, and in line with the relative responsibilities of primary and secondary care, use of the quality indicators has the potential to improve care and to improve the physical and mental health of people with SMI. However, before the indicators can be used to monitor or incentivise primary care quality, more robust links need to be established, with improved patient outcomes.
严重精神疾病（SMI）——包括精神分裂症、双相情感障碍和其他精神病等长期病症——给患者和社会带来了巨大代价。在许多国家，患有严重精神疾病的人仅在初级保健机构接受治疗，并且对身体护理有特殊需求。
本研究的目的是系统回顾文献，以创建一份与严重精神疾病患者相关的质量指标清单，这些指标可通过常规数据获取，并可用于监测或激励提高初级保健质量。
系统文献回顾，结合对质量指标数据库和指南的检索。
作者评估了指标是否可从常规数据中测量以及证据的质量。
在识别出的1847篇论文和质量指标数据库中，纳入了27篇，从中确定了59个质量指标，涵盖六个领域。在这59个指标中，52个可通过常规数据进行评估。支撑这些指标的证据基础相对薄弱，主要基于专家意见而非试验证据。
通过针对不同情况进行适当调整，并符合初级和二级保健的相对职责，使用质量指标有可能改善护理，并改善严重精神疾病患者的身心健康。然而，在这些指标可用于监测或激励初级保健质量之前，需要建立更有力的联系，并改善患者的治疗效果。
