Corral Gudino L, Borao Cengotita-Bengoa M, Jorge Sánchez R J, García Aparicio J
Hospital El Bierzo. Gerencia de Asistencia Sanitaria del Bierzo.
An Sist Sanit Navar. 2017 Dec 29;40(3):443-459. doi: 10.23938/ASSN.0119.
Health services are moving towards a complete integration to try and reduce fragmentation, increase efficiencies and improve health outcomes. Estimates the effectiveness in of different tools for integrated care in Spain.
We performed a systematic review of articles using MEDLINE (last search July31st, 2017). Randomized clinical trials reporting health outcomes of tools for integrated care used in Spain were included. Studies were appraised for quality using the Cochrane Risk of Bias assessment.
Twenty studies met the criteria for the systematic review. Interventions included were hospital-at home (four studies, 455 patients), outpatient clinic by videoconference (three studies, 2438 patients), nurse navigator (four studies, 1051 patients), self-care improvement (four studies, 1291 patients), at-home health monitoring (three, 162), health apps (two, 225) and medical reconciliation (one, 172). Hospital-at-home, nurse navigator or self-care improvement reduced readmission rate in older patients, heart failure (HF) or chronic obstructive pulmonary disease (COPD). Self-care improvement and nurse navigator reduced mortality rate in HF. Hospital-at-home reduced hospital stay in COPD. Self-care improvement reduced outpatient visits in asthma patients. Outpatient video by videoconference reduced time to diagnosis and treatment in rural areas. The quality of the evidence ranged from low to very low for all the outcomes because it was based in double or triple downgraded randomized trials.
The implementation of tools for integrated care in Spain improved some outcomes of relevance in patients with chronic conditions, although evidence is low. Self-care improvement stood out due to the improvements made.
卫生服务正朝着全面整合的方向发展，以试图减少碎片化、提高效率并改善健康结果。评估西班牙不同综合护理工具的有效性。
我们使用MEDLINE（最后一次检索时间为2017年7月31日）对文章进行了系统综述。纳入了报告西班牙使用的综合护理工具健康结果的随机临床试验。使用Cochrane偏倚风险评估对研究质量进行评价。
20项研究符合系统综述的标准。纳入的干预措施包括居家医院护理（4项研究，455例患者）、视频会议门诊（3项研究，2438例患者）、护士导航（4项研究，1051例患者）、自我护理改善（4项研究，1291例患者）、居家健康监测（3项研究，162例患者）、健康应用程序（2项研究，225例患者）和药物重整（1项研究，172例患者）。居家医院护理、护士导航或自我护理改善降低了老年患者、心力衰竭（HF）或慢性阻塞性肺疾病（COPD）患者的再入院率。自我护理改善和护士导航降低了HF患者的死亡率。居家医院护理缩短了COPD患者的住院时间。自我护理改善减少了哮喘患者的门诊就诊次数。视频会议门诊缩短了农村地区的诊断和治疗时间。由于所有结果均基于经过双重或三重降级的随机试验，证据质量从低到极低。
西班牙综合护理工具的实施改善了慢性病患者的一些相关结果，尽管证据质量较低。自我护理改善因其取得的成效而突出。
