Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
Harris Manchester College, Oxford, OX1 3TD, UK.
BMC Health Serv Res. 2020 Apr 26;20(1):358. doi: 10.1186/s12913-020-05206-5.
As people are living longer with higher incidences of long-term health conditions, there is a move towards greater integration of care, including integration of health and social care services. Integrated care needs to be comprehensively and systematically evaluated if it is to be implemented widely. We performed a systematic review of reviews to identify measures which have been used to assess integrated care across health and social care services for people living with long-term health conditions.
Four electronic databases (PUBMED; MEDLINE; EMBASE; Cochrane library of systematic reviews) were searched in August 2018 for relevant reviews evaluating the integration of health and social care between 1998 and 2018. Articles were assessed according to apriori eligibility criteria. A data extraction form was utilised to collate the identified measures into five categories.
Of the 18 articles included, system outcomes and process measures were most frequently identified (15 articles each). Patient or carer reported outcomes were identified in 13 articles while health outcomes were reported in 12 articles. Structural measures were reported in nine articles. Challenges to measuring integration included the identification of a wide range of potential impacts of integration, difficulties in comparing findings due to differences in study design and heterogeneity of types of outcomes, and a need for appropriate, robust measurement tools.
Our review revealed no shortage of measures for assessing the structures, processes and outcomes of integrated care. The very large number of available measures and infrequent use of any common set make comparisons between schemes more difficult. The promotion of core measurement sets and stakeholder consultation would advance measurement in this area.
随着人们的寿命延长，长期健康状况的发生率也越来越高，因此需要更加注重医疗保健的整合，包括卫生和社会保健服务的整合。如果要广泛实施整合护理，就需要对其进行全面和系统的评估。我们对综述进行了系统评价，以确定用于评估长期健康人群的卫生和社会保健服务整合的措施。
2018 年 8 月，我们在四个电子数据库（PUBMED、MEDLINE、EMBASE、Cochrane 系统评价图书馆）中搜索了 1998 年至 2018 年期间评估卫生和社会保健整合的相关综述。文章根据事先确定的资格标准进行评估。使用数据提取表格将确定的措施分为五类。
在纳入的 18 篇文章中，系统结果和过程措施最常被识别（各有 15 篇文章）。13 篇文章中报告了患者或照顾者报告的结果，12 篇文章中报告了健康结果。9 篇文章报告了结构措施。衡量整合的挑战包括确定整合的广泛潜在影响、由于研究设计和结果类型的异质性导致难以比较发现，以及需要适当、稳健的衡量工具。
我们的综述表明，评估整合护理的结构、过程和结果的措施并不缺乏。可用的措施非常多，而任何常见措施的使用频率都较低，这使得方案之间的比较更加困难。推广核心衡量标准和利益相关者协商将有助于该领域的衡量工作。
