Institute for Health and Society, Newcastle University, Richardson Road, Newcastle-Upon-Tyne NE2 4AF, UK.
Int J Nurs Stud. 2018 Mar;79:27-35. doi: 10.1016/j.ijnurstu.2017.10.013. Epub 2017 Nov 10.
Evidence-based care for people with dementia is a priority for patients, carers and clinicians and a policy priority. There is evidence that people with dementia do not always receive such care. Audit and feedback, also known as clinical audit, is an extensively-used intervention to improve care. However, there is uncertainty about the best way to use it.
To investigate whether audit and feedback is effective for improving health professionals' care of people with dementia. To investigate whether the content and delivery of audit and feedback affects its effectiveness in the context of health professionals' care for people with dementia.
Systematic review DATA SOURCES: The Cochrane Central Register of Controlled Trials, Prospero, Medline (1946-December week 1 2016), PsycInfo (1967-January 2017), Cinahl (1982-January 2017), HMIC (1979-January 2017), Embase (1974-2017 week 1) databases and the Science Citation Index and Social Science Citation Index were searched combining terms for audit and feedback, health personnel, and dementia.
Following screening, the data were extracted using the Template for Intervention Description and Replication (TIDieR), and synthesised graphically using harvest plots and narratively.
Thirteen studies met the inclusion criteria. Published studies of audit and feedback in dementia rarely described more than one cycle. None of the included studies had a comparison group: 12 were before and after designs and one was an interrupted time series without a comparison group. The median absolute improvement was greater than in studies beyond dementia which have used stronger designs with fewer risks of bias. Included studies demonstrated large variation in the effectiveness of audit and feedback.
Whilst methodological and reporting limitations in the included studies hinder the ability to draw strong conclusions on the effectiveness of audit and feedback in dementia care, the large interquartile range indicates further work is needed to understand the factors which affect the effectiveness of this much-used intervention.
为痴呆患者提供循证护理是患者、护理人员和临床医生的首要任务，也是政策重点。有证据表明，痴呆患者并不总是接受此类护理。审核和反馈（也称为临床审核）是一种广泛使用的干预措施，可改善护理。但是，对于如何最好地使用它存在不确定性。
调查审核和反馈是否可有效改善卫生专业人员对痴呆患者的护理。调查审核和反馈的内容和提供方式是否会影响其在卫生专业人员对痴呆患者护理中的有效性。
系统评价
Cochrane 对照试验中心注册库、Prospéro、Medline（1946 年-12 月第 1 周）、PsycInfo（1967 年-1 月）、Cinahl（1982 年-1 月）、HMIC（1979 年-1 月）、Embase（1974 年-2017 年第 1 周）数据库以及科学引文索引和社会科学引文索引，通过组合审核和反馈、卫生人员和痴呆的术语进行检索。
筛选后，使用干预描述和复制模板（TIDieR）提取数据，并使用收获图和叙述性方法进行图形化汇总。
有 13 项研究符合纳入标准。发表的痴呆症审核和反馈研究很少描述超过一个周期。没有一项纳入研究有对照组：12 项为前后设计，1 项为无对照组的中断时间序列。绝对改善中位数大于使用设计更强、偏倚风险更小的痴呆症以外的研究。纳入的研究表明，审核和反馈的有效性存在很大差异。
尽管纳入研究在方法学和报告方面存在局限性，限制了对痴呆护理中审核和反馈有效性的有力结论，但较大的四分位间距表明，需要进一步研究以了解影响这种广泛使用干预措施有效性的因素。
