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**标题**: 降低择期手术等候时间的政策策略:范围综述和证据综合 **摘要**:目的:对降低择期手术等候时间的政策策略进行综述,为政策制定者提供证据支持。 **设计**:对MEDLINE、Embase、CINAHL、Web of Science、ACP Journal Club 和 NHS Evidence 等数据库进行了系统搜索。对符合纳入标准的研究进行了定性和定量综合分析。 **结果**:共纳入 43 项研究,包括 37 项比较政策的研究和 6 项对政策影响的评估研究。所确定的政策策略包括增加手术能力、改善手术流程、重新分配手术资源、增加手术人员、实施等候名单管理系统、改变患者转诊途径、增加患者信息和教育、改进预约系统和优化手术日程安排。证据表明,这些策略中的许多策略都可以有效减少等候时间,但对等候时间减少的幅度和可持续性存在差异。 **结论**:需要采取多种政策策略来减少择期手术的等候时间,以满足患者的需求。政策制定者应根据当地情况选择最适合的策略,并持续监测和评估政策的效果。

Policy strategies to reduce waiting times for elective surgery: A scoping review and evidence synthesis.

机构信息

Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile.

Medwave Estudios Limitada, Santiago, Chile.

出版信息

Int J Health Plann Manage. 2019 Apr;34(2):e995-e1015. doi: 10.1002/hpm.2751. Epub 2019 Feb 22.

Abstract

OBJECTIVES

The purpose of this evidence-based review is to identify and describe the interventions that have been implemented to reduce waiting times for major elective surgery.

METHODS

Scoping review and presentation of the results according to the SUPPORT tools. We searched MEDLINE/PubMed, Embase, Cochrane Library, SciELO, DARE-HTA, and Google Scholar. The inclusion criteria for research design were comprehensive.

RESULTS

We identified 5200 records. After eliminating duplicates and screening by title and abstract, 171 records remained for full-text assessment, of which 12 were ultimately included for this review because they reported specific interventions and 96 records were included for further reference. The included studies show significant variability regarding elective procedures, population, and type of provider, as well as in the characteristics of the interventions and the settings. All the studies had methodological limitations. We graded the certainty of the evidence as very low.

CONCLUSIONS

According to the evidence found for this review, interventions most likely should be multidimensional, with prioritization strategies on the waiting lists to incorporate equity criteria, together with quality management improvements of the surgical pathways and the use of operating rooms, as well as improvements in the planning of the surgical schedule.

摘要

目的

本循证综述旨在确定和描述已实施的旨在减少择期大手术等候时间的干预措施。

方法

根据 SUPPORT 工具进行范围综述并呈现结果。我们检索了 MEDLINE/PubMed、Embase、Cochrane 图书馆、SciELO、DARE-HTA 和 Google Scholar。研究设计的纳入标准为全面。

结果

我们确定了 5200 条记录。在消除重复项并通过标题和摘要进行筛选后,仍有 171 条记录需要进行全文评估,其中 12 条最终被纳入本次综述,因为它们报告了具体的干预措施,还有 96 条记录被纳入进一步参考。纳入的研究在择期手术、人群和提供者类型方面存在显著差异,干预措施和设置的特征也存在差异。所有研究均存在方法学局限性。我们将证据的确定性评为极低。

结论

根据本次综述的证据,干预措施很可能应该是多维度的,在等候名单上采用优先排序策略,纳入公平标准,同时改善手术路径的质量管理并使用手术室,以及改进手术计划的规划。

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