通过多团队系统视角剖析照护协调：概念框架与系统综述。

Unpacking Care Coordination Through a Multiteam System Lens: A Conceptual Framework and Systematic Review.

机构信息

Johns Hopkins University School of Medicine.

Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, MD.

出版信息

Med Care. 2018 Mar;56(3):247-259. doi: 10.1097/MLR.0000000000000874.

DOI:10.1097/MLR.0000000000000874

PMID:29356720

Abstract

BACKGROUND

The 2016 President's Cancer Panel Connected Health report calls for thoroughly characterizing the team structures and processes involved in coordinating care for people with chronic conditions. We developed a multilevel care coordination framework by integrating existing frameworks from the teams and care coordination literatures, and used it to review evidence examining care coordination processes for patients with cancer, diabetes, cardiovascular disease, and combinations of these conditions.

METHODS

We searched Pubmed/MedLINE, CINAHL Plus, Cochrane, PsycINFO (December 2009-June 2016), and references from previous reviews. Studies describing behavioral markers of coordination between ≥2 US health care providers caring for adults with cancer, chronic heart disease, diabetes, or populations with a combination of these conditions were included. Two investigators screened 4876 records and 180 full-text articles yielding 33 studies. One investigator abstracted data, a second checked abstractions for accuracy.

RESULTS

Most studies identified information sharing or monitoring as key coordination processes. To execute these processes, most studies used a designated role (eg, coordinator), objects and representations (eg, survivorship plans), plans and rules (eg, protocols), or routines (eg, meetings). Few examined the integrating conditions. None statistically examined coordination processes or integrating conditions as mediators of relationships between specific coordination mechanisms and patient outcomes.

LIMITATIONS

Restricted to United States, English-language studies; heterogeneity in methods and outcomes.

CONCLUSIONS

Limited research unpacks relationships between care coordination mechanisms, coordination processes, integrating conditions, and patient outcomes suggested by existing theory. The proposed framework offers an organizer for examining behaviors and conditions underlying effective care coordination.

摘要

背景

2016 年总统癌症小组的互联健康报告呼吁全面描述协调慢性病患者护理所涉及的团队结构和流程。我们通过整合团队和护理协调文献中的现有框架，开发了一个多层次的护理协调框架，并使用该框架审查了考察癌症、糖尿病、心血管疾病患者护理协调流程的证据，以及这些疾病组合的患者。

方法

我们在 Pubmed/MedLINE、CINAHL Plus、Cochrane、PsycINFO（2009 年 12 月至 2016 年 6 月）和以前综述的参考文献中进行了搜索。纳入描述≥2 名美国卫生保健提供者之间协调行为标志物的研究，这些提供者照顾患有癌症、慢性心脏病、糖尿病或这些疾病组合的成年人。两名调查员筛选了 4876 条记录和 180 篇全文文章，得出 33 项研究。一名调查员提取数据，第二名调查员检查提取数据的准确性。

结果

大多数研究确定了信息共享或监测是关键的协调流程。为了执行这些流程，大多数研究使用了指定的角色（例如，协调员）、对象和表示形式（例如，生存计划）、计划和规则（例如，协议）或例程（例如，会议）。很少有研究考察整合条件。没有一项研究从统计学上考察协调流程或整合条件作为特定协调机制与患者结果之间关系的中介。