Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, P.O. Box 201-B, Ottawa, Ontario, K1H 8L6, Canada.
Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada.
Syst Rev. 2019 Feb 11;8(1):50. doi: 10.1186/s13643-019-0948-1.
There is increasing recognition in Canada and globally that a substantial proportion of health care delivered is inappropriate as evidenced by (1) harmful and/or ineffective practices being overused, (2) effective clinical practices being underused, and (3) other clinical practices being misused. Inappropriate health care leads to negative patient experiences, poor health outcomes, and inefficient use of scarce health care resources. The purpose of this study is to conduct a systematic review of inappropriate health care in Canada. Our specific objectives are to (1) systematically search and critically review published and grey literature for studies on inappropriate health care in Canada; (2) estimate the nature and magnitude of inappropriate health care in Canada and its provincial and territorial jurisdictions.
We will include all quantitative study designs reporting objective or subjective measurements of inappropriate health care in Canada over the last 10 years. We will search the following online databases: MEDLINE, Cochrane Central Register of Controlled Trials, EconLit, and ISI-Web of Knowledge, which contains Web of Science Core Collection-Citation Indexes, Science Citation Index Expanded, Conference Proceedings Citation Index-Science, and Conference Proceedings Citation Index-Social Science & Humanities. We will also search grey literature sources to identify provincial and national audits of inappropriate health care. Two authors will independently screen, assess data quality, and extract data for synthesis. Study findings will be synthesized narratively. We will organize our data into three care categorizations: preventive care, acute care, and chronic care. We will provide a compendium of inappropriate health care for each care category for Canada and each Canadian province and territory, where sufficient data exists, by calculating (1) overall medians of underuse, overuse, and misuse of clinical practices and (2) the range of medians of underuse, overuse, and misuse for each clinical practice investigated.
This review will result in the first-ever evidence-based compendium of inappropriate health care in Canada. We will also develop detailed reports of inappropriate health care for each Canadian province and territory.
PROSPERO CRD42018093495.
加拿大和全球范围内越来越认识到，相当一部分提供的医疗保健是不适当的，这表现在以下三个方面：（1）过度使用有害和/或无效的做法，（2）未充分利用有效的临床实践，以及（3）误用其他临床实践。不适当的医疗保健会导致患者体验不佳、健康状况不佳和医疗资源利用效率低下。本研究的目的是对加拿大的不适当医疗保健进行系统审查。我们的具体目标是：（1）系统地搜索和批判性地审查已发表和灰色文献中关于加拿大不适当医疗保健的研究；（2）估计加拿大及其省级和地区不适当医疗保健的性质和程度。
我们将包括所有在过去 10 年中报告加拿大不适当医疗保健的客观或主观测量的定量研究设计。我们将搜索以下在线数据库：MEDLINE、Cochrane 中央对照试验注册中心、EconLit 和 ISI-Web of Knowledge，其中包含 Web of Science 核心集合-引文索引、科学引文索引扩展、会议论文集引文索引-科学和会议论文集引文索引-社会科学与人文。我们还将搜索灰色文献来源，以确定对不适当医疗保健的省级和国家级审计。两位作者将独立筛选、评估数据质量并提取数据进行综合。研究结果将以叙述性方式进行综合。我们将把我们的数据分为三个护理类别：预防保健、急性保健和慢性保健。我们将为加拿大和每个加拿大省和地区提供不适当医疗保健的汇编，在有足够数据的情况下，通过计算（1）临床实践的未使用率、过度使用率和误用率的总体中位数，以及（2）调查的每个临床实践的未使用率、过度使用率和误用率的中位数范围。
本次审查将产生加拿大有史以来第一份基于证据的不适当医疗保健汇编。我们还将为每个加拿大省和地区编写不适当医疗保健的详细报告。
PROSPERO CRD42018093495。
