现场医护人员和辅助医疗人员针对减少长期护理患者急诊就诊的治疗干预措施的安全性和有效性的系统评价方案。

The safety and efficacy of on-site paramedic and allied health treatment interventions targeting the reduction of emergency department visits by long-term care patients: systematic review protocol.

机构信息

Ottawa Paramedic Service, 2465 Don Reid Dr, Ottawa, Ontario, K1H 1E2, Canada.

Department of Emergency Medicine, University of Ottawa at The Ottawa Hospital, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.

出版信息

Syst Rev. 2018 Nov 23;7(1):206. doi: 10.1186/s13643-018-0868-5.

DOI:10.1186/s13643-018-0868-5

PMID:30470243

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6260877/

Abstract

BACKGROUND

Older adults are more likely to access the emergency department, which suffers from overcrowding and congestion, for conditions that could potentially be treated in other settings. Older adults living in long-term care centers have access to healthcare resources in their residence, and several programs have been created with the intent of treating medical conditions on-site. The aim of this study is to identify and systematically review programs and interventions at long-term care centers that aim to treat patients on-site, avoiding unscheduled transportation to the emergency department.

METHODS

We will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We will perform a comprehensive search of Embase, MEDLINE, CINAHL, ClinicalTrials.gov , PROSPERO, and the Cochrane Central Registry of Controlled Trials using a broad search strategy. Two independent reviewers will assess titles and abstracts against inclusion criteria, and we will further evaluate relevant full-text articles for inclusion. We will assess the risk of bias using the Newcastle-Ottawa scale for included non-randomized studies and the Cochrane Risk of Bias tool for randomized trials. We will present a narrative synthesis of results and complete a meta-analysis only if enough homogeneity is found. We will create funnel plots to evaluate possible reporting bias and use The Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology to assess the confidence in cumulative evidence.

DISCUSSION

As pressure on the healthcare system continues to rise, many areas are looking for alternative models of care. Several programs have been put in place in long-term care centers that seek to avoid transportation to the emergency department by providing enhanced care on-site. These programs are quite variable, and, to date, there is no standardized program or model of care.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO ( CRD42018091636 ).

摘要

背景

老年人更有可能因潜在可在其他环境中治疗的疾病而前往经常人满为患的急诊部门。居住在长期护理中心的老年人可以在其居住的地方获得医疗资源，并且已经创建了几个旨在现场治疗医疗条件的项目。本研究的目的是确定并系统地审查长期护理中心旨在现场治疗患者的项目和干预措施，避免无计划地将患者送往急诊部门。

方法

我们将遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。我们将使用广泛的搜索策略，在 Embase、MEDLINE、CINAHL、ClinicalTrials.gov、PROSPERO 和 Cochrane 对照试验中心注册处对 Embase、MEDLINE、CINAHL、ClinicalTrials.gov、PROSPERO 和 Cochrane 对照试验中心注册处进行全面搜索。两名独立评审员将根据纳入标准评估标题和摘要，并进一步评估相关的全文文章是否纳入。我们将使用纽卡斯尔-渥太华量表（Newcastle-Ottawa scale）评估非随机研究的偏倚风险，并使用 Cochrane 偏倚风险工具（Cochrane Risk of Bias tool）评估随机试验的偏倚风险。我们将呈现结果的叙述性综合，并仅在发现足够同质性时进行荟萃分析。我们将创建漏斗图来评估可能存在的报告偏倚，并使用推荐评估、制定与评价（GRADE）方法学来评估累积证据的置信度。