围手术期结构和流程质量及安全指标：系统评价。
Perioperative structure and process quality and safety indicators: a systematic review.
机构信息
Institute of Epidemiology and Applied Health Research, UK; UCLH Surgical Outcomes Research Centre, Department of Applied Health Research, UK; Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK; National Institute for Academic Anaesthesia's Health Services Research Centre, Royal College of Anaesthetists, London, UK.
Institute of Epidemiology and Applied Health Research, UK; UCLH Surgical Outcomes Research Centre, Department of Applied Health Research, UK; Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK; National Institute for Academic Anaesthesia's Health Services Research Centre, Royal College of Anaesthetists, London, UK.
出版信息
Br J Anaesth. 2018 Jan;120(1):51-66. doi: 10.1016/j.bja.2017.10.001. Epub 2017 Nov 24.
BACKGROUND
Clinical indicators assess healthcare structures, processes, and outcomes. While used widely, the exact number and level of scientific evidence of these indicators remains unclear. The aim of this study was to evaluate the number, type, and evidence base of clinical process and structure indicators currently available for quality and safety measurement in perioperative care.
METHODS
We performed a systematic review searching Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Google Scholar, and System for Information in Grey Literature in Europe databases for English language human studies in adults (age >18) published in the past 10 years (January 2005-January 2016). We also included professional and governmental body publications and guidelines describing the development, validation, and use of structure and process indicators in perioperative care.
RESULTS
We identified 43 860 journal articles and 43 relevant indicator program publications. From these, we identified a total of 1282 clinical indicators, split into structure (36%, n=463) and process indicators (64%, n=819). The dimensions of quality most frequently addressed were effectiveness (38%, n=475) and patient safety (29%, n=363). The majority of indicators (53%, n=675) did not have a level of evidence ascribed in their literature. Patient-centred metrics accounted for the fewest published clinical indicators.
CONCLUSIONS
Despite widespread use, the majority of clinical indicators are not based on a strong level of scientific evidence. There may be scope in setting standards for the development and validation process of clinical indicators. Most indicators focus on the effectiveness, safety, and efficiency of care.
PROSPERO DATABASE
CRD4201501277.
背景
临床指标评估医疗保健的结构、过程和结果。尽管这些指标被广泛应用，但确切数量和科学证据水平仍不清楚。本研究旨在评估目前可用于围手术期护理质量和安全测量的临床过程和结构指标的数量、类型和证据基础。
方法
我们进行了系统评价，检索了 Medline、Embase、Cumulative Index to Nursing and Allied Health Literature（CINAHL）、Cochrane、Google Scholar 和 System for Information in Grey Literature in Europe 数据库，以获取过去 10 年（2005 年 1 月至 2016 年 1 月）发表的英语成人（年龄>18 岁）的人类研究。我们还包括描述围手术期护理结构和过程指标的开发、验证和使用的专业和政府机构出版物和指南。
结果
我们确定了 43860 篇期刊文章和 43 篇相关指标计划出版物。从中，我们共确定了 1282 个临床指标，分为结构指标（36%，n=463）和过程指标（64%，n=819）。质量维度中最常涉及的是有效性（38%，n=475）和患者安全（29%，n=363）。大多数指标（53%，n=675）在文献中没有赋予证据水平。以患者为中心的指标占发表的临床指标最少。
结论
尽管广泛应用，但大多数临床指标都没有基于强有力的科学证据。在为临床指标的开发和验证过程设定标准方面可能有一定的空间。大多数指标都侧重于护理的有效性、安全性和效率。
PROSPERO 数据库：CRD4201501277。
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