综合护理干预对改善慢性病患者生活质量（QoL）的有效性。系统评价证据概述。
The effectiveness of integrated care interventions in improving patient quality of life (QoL) for patients with chronic conditions. An overview of the systematic review evidence.
作者信息
Flanagan Sarah, Damery Sarah, Combes Gill
机构信息
Research Fellow, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, West Midlands, B15 2TT, UK.
Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands Research Lead for Chronic Conditions Theme, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, West Midlands, B15 2TT, UK.
出版信息
Health Qual Life Outcomes. 2017 Sep 29;15(1):188. doi: 10.1186/s12955-017-0765-y.
OBJECTIVE
To determine the effectiveness of integrated care interventions in improving the Quality of Life (QoL) for patients with chronic conditions.
DESIGN
A review of the systematic reviews evidence (umbrella review).
DATA SOURCES
Medline, Embase, ASSIA, PsychINFO, HMIC, CINAHL, Cochrane Library (including HTA database), DARE, and Cochrane Database of Systematic Reviews), EPPI-Centre, TRIP and Health Economics Evaluations databases. Reference lists of included reviews were searched for additional references not returned by electronic searches.
REVIEW METHODS
English language systematic reviews or meta-analyses published since 2000 that assessed the effectiveness of interventions in improving the QoL of patients with chronic conditions. Two reviewers independently assessed reviews for eligibility, extracted data, and assessed the quality of included studies.
RESULTS
A total of 41 reviews assessed QoL. Twenty one reviews presented quantitative data, 17 reviews were narrative and three were reviews of reviews. The intervention categories included case management, Chronic care model (CCM), discharge management, multidisciplinary teams (MDT), complex interventions, primary vs. secondary care follow-up, and self-management.
CONCLUSIONS
Taken together, the 41 reviews that assessed QoL provided a mixed picture of the effectiveness of integrated care interventions. Case management interventions showed some positive findings as did CCM interventions, although these interventions were more likely to be effective when they included a greater number of components. Discharge management interventions appeared to be particularly successful for patients with heart failure. MDT and self-management interventions showed a mixed picture. In general terms, interventions were typically more effective in improving condition-specific QoL rather than global QoL. This review provided the first overview of international evidence for the effectiveness of integrated care interventions for improving the QoL for patients with chronic conditions.
目的
确定综合护理干预措施对改善慢性病患者生活质量（QoL）的有效性。
设计
对系统评价证据的综述（伞状综述）。
数据来源
Medline、Embase、ASSIA、PsychINFO、HMIC、CINAHL、Cochrane图书馆（包括卫生技术评估数据库）、DARE以及Cochrane系统评价数据库、EPPI中心、TRIP和卫生经济学评估数据库。检索纳入综述的参考文献列表，以获取电子检索未返回的其他参考文献。
综述方法
检索2000年以来发表的英文系统评价或Meta分析，这些研究评估了干预措施改善慢性病患者QoL的有效性。两名评价员独立评估综述的纳入资格、提取数据并评估纳入研究的质量。
结果
共有41项综述评估了QoL。21项综述呈现了定量数据，17项综述为叙述性综述，3项为综述的综述。干预类别包括病例管理、慢性病护理模式（CCM）、出院管理、多学科团队（MDT）、综合干预、初级与二级护理随访以及自我管理。
结论
综合来看，这41项评估QoL的综述对综合护理干预措施的有效性呈现出复杂的情况。病例管理干预措施显示出一些积极结果，CCM干预措施也是如此，不过当这些干预措施包含更多组成部分时，它们更有可能有效。出院管理干预措施对心力衰竭患者似乎特别成功。MDT和自我管理干预措施呈现出复杂的情况。一般而言，干预措施在改善特定疾病的QoL方面通常比整体QoL更有效。本综述首次概述了综合护理干预措施改善慢性病患者QoL有效性的国际证据。
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