Becker Ellen A, Hoerr Cheryl A, Wiles Kimberly S, Skees Debra L, Miller Corinne H, Laher Douglas S
Department of Cardiopulmonary Sciences, Rush University Medical Center, Chicago, IL.
Department of Respiratory and Sleep Services; Phelps County Regional Medical Center, Rolla, MO.
Respir Care. 2018 Jan;63(1):102-117. doi: 10.4187/respcare.05808. Epub 2017 Nov 28.
Changes to the reimbursement of respiratory care services over the past 26 years make it imperative that respiratory therapists (RTs) demonstrate cost savings to establish their value. Therefore, this systematic review evaluated the cost-related impacts from utilizing RTs to deliver care when compared to other care providers.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to guide the search process. The study addressed articles across all age groups and care settings that compared the cost of care provided by RTs to a comparison group. Studies were excluded if they were not written in English, described care provided outside of the United States, did not provide quantitative data, or lacked a comparison group.
A total of 4,120 articles emerged from the search process, of which 60 qualified for a full text review. Cost savings were evaluated for the 28 articles included in this review, noting the study design, the specific respiratory care practice, use of protocols, clinical setting, and age group. The most frequently studied topic was mechanical ventilation, which along with disease management represented by the most randomized, controlled trials for the study design. The clinical practice area notably absent was home care.
Although cost comparisons across studies could not be made due to the inconsistent manner in which data were reported, evidence demonstrated that care provided by RTs yielded both direct and indirect cost reductions, which were achieved through protocol utilization, specialized expertise, and autonomous decision making. The care provided was consistent with care provided by other disciplines. It is critical for the respiratory care profession to highlight key clinical practice areas for future research, to establish uniform reporting measures for outcomes, and to foster the development of future respiratory care researchers to affirm the value that respiratory therapists add to patient care.
在过去26年中，呼吸护理服务报销政策的变化使得呼吸治疗师（RTs）必须证明能够节省成本以确立自身价值。因此，本系统评价评估了与其他护理提供者相比，利用RTs提供护理所产生的成本相关影响。
采用系统评价和Meta分析的首选报告项目指南来指导检索过程。该研究涉及所有年龄组和护理环境中比较RTs提供的护理成本与对照组的文章。如果文章不是用英文撰写、描述美国境外提供的护理、未提供定量数据或缺乏对照组，则将其排除。
检索过程共产生4120篇文章，其中60篇符合全文审查标准。对本评价纳入的28篇文章进行了成本节省评估，记录了研究设计、具体的呼吸护理实践、方案的使用、临床环境和年龄组。研究最频繁的主题是机械通气，以及以疾病管理为代表的研究设计中随机对照试验最多的领域。明显缺失的临床实践领域是家庭护理。
尽管由于数据报告方式不一致，无法在各项研究之间进行成本比较，但证据表明，RTs提供的护理产生了直接和间接的成本降低，这是通过方案利用、专业知识和自主决策实现的。所提供的护理与其他学科提供的护理一致。对于呼吸护理专业来说，突出未来研究的关键临床实践领域、建立统一的结果报告措施以及促进未来呼吸护理研究人员的发展，以肯定呼吸治疗师为患者护理所增加的价值至关重要。
