以患者为中心的肿瘤护理对医疗利用和成本的影响：系统评价和荟萃分析。
The patient-centered oncology care on health care utilization and cost: A systematic review and meta-analysis.
机构信息
Hailun Liang, DrPH, MSc, is Assistant Professor, School of Public Administration and Policy, Renmin University of China, Beijing, China. E-mail:
出版信息
Health Care Manage Rev. 2020 Oct/Dec;45(4):364-376. doi: 10.1097/HMR.0000000000000226.
BACKGROUND
Optimal cancer care entails coordination among multiple providers and continued follow-up and surveillance over time. The patient-centered care brings opportunities to improve the delivery of cancer care. The adoption of patient-centered oncology care (PCOC) is in its infancy. Evidence synthesis on the model's effectiveness is scant.
PURPOSES
This is the first systemic review and meta-analysis on associations of PCOC with cancer patients' adverse health care utilization, cost, patient satisfaction, and quality of care.
METHODS
Our study was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) framework. Quality appraisal was performed using Downs and Black's quality checklist. Study-level effect sizes of adverse health care utilization were computed using Cohen's d and summarized using forest plots. Funnel plots were constructed to examine publication bias.
RESULTS
Of 334 studies that were reviewed, 10 met eligibility criteria and were included into the final analysis. Many included studies implemented almost all six of patient-centered care core attributes, plus three additional attributes that specifically addressed cancer patients' needs, including triage pathways, standardized and evidence-based symptom management, as well as support patient navigation. PCOC patients had lower utilization of inpatient care (standardized means difference [SMD] = -0.027, p = .049). Overall positive effect of PCOC on emergency department use was small and not significant (SMD = -0.023, p = .103). With regard to cost and quality of care, our narrative summaries showed an overall positive direction, though we found limitations in individual study quality that precluded a meta-analysis.
PUBLIC IMPLICATION
The results showed that it is possible to utilize patient-centered model to support best practice of cancer care. Early evidence shows that the PCOC model has potential to improve health care utilization, cost, and quality of care, but limited numbers of included articles and heterogeneity of those studies implied that more rigorous research is expected to further investigate the model's effects.
背景
癌症的最佳治疗需要多个提供者之间的协调，并随着时间的推移持续进行随访和监测。以患者为中心的护理带来了改善癌症护理服务的机会。以患者为中心的肿瘤护理（PCOC）的采用仍处于起步阶段。关于该模式有效性的证据综合很少。
目的
这是第一项关于 PCOC 与癌症患者不良医疗保健利用、成本、患者满意度和护理质量之间关联的系统评价和荟萃分析。
方法
我们的研究遵循 PRISMA（系统评价和荟萃分析的首选报告项目）框架。使用唐斯和布莱克的质量检查表进行质量评估。使用 Cohen's d 计算不良医疗保健利用的研究水平效应大小，并使用森林图进行总结。构建漏斗图以检查发表偏倚。
结果
在审查的 334 项研究中，有 10 项符合纳入标准并纳入最终分析。许多纳入的研究实施了几乎所有的患者中心护理的六个核心属性，再加上三个专门针对癌症患者需求的额外属性，包括分诊途径、标准化和基于证据的症状管理，以及支持患者导航。PCOC 患者的住院护理利用率较低（标准化均数差值 [SMD] = -0.027，p =.049）。总体而言，PCOC 对急诊使用的积极影响较小且不显著（SMD = -0.023，p =.103）。关于成本和护理质量，我们的叙述性总结显示出总体积极的方向，尽管我们发现个别研究质量存在局限性，这使得无法进行荟萃分析。
公众影响
结果表明，利用以患者为中心的模式支持癌症护理的最佳实践是可能的。早期证据表明，PCOC 模式有可能改善医疗保健的利用、成本和护理质量，但纳入的文章数量有限，这些研究的异质性意味着需要更严格的研究来进一步调查该模式的效果。
Zotero 插件