Stark Susanne, Ewers Michael
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Health and Nursing Science, Berlin, DE.
Int J Integr Care. 2020 Jul 17;20(3):3. doi: 10.5334/ijic.5429.
Patients with long-term tracheostomies, with or without mechanical ventilation have complex and comprehensive healthcare needs. The number of patients is increasing internationally. Evidence suggests poor healthcare quality and outcomes, especially in Germany. Against this background, we searched for international concepts tailoring healthcare to these special needs, their key characteristics and results from their evaluations.
A scoping review was performed in 2018 based on a systematic search of scientific databases and grey literature without restrictions to publication type. Key information was charted and thematically analysed based on the taxonomy of integrated care. Evaluations were analysed descriptively.
Seventy-nine publications related to 25 programmes from five countries were included. Healthcare concepts are usually regionally adapted and tertiary sector-based with a cross-sectoral approach. Care coordination responsibility is usually assigned to advanced nurse practitioners, embedded in multi-professional programme teams. Interventions consist of specialised needs-based clinical services combined with care coordination, homecare support and education. Evaluation of concepts is scarce, but existing results indicate beneficial effects on patient-related outcomes, care coordination, healthcare utilisation and costs.
The concepts available in the literature are often poorly described and rarely evaluated. Research is needed on their impact on healthcare quality and outcomes. However, several key characteristics were identified, which should be considered when developing and implementing integrated and needs-based approaches for the patient group in Germany and beyond.
长期接受气管造口术的患者，无论是否使用机械通气，都有复杂而全面的医疗保健需求。国际上这类患者的数量正在增加。有证据表明医疗保健质量和结果不佳，尤其是在德国。在此背景下，我们寻找针对这些特殊需求的国际医疗保健概念、其关键特征以及评估结果。
2018年进行了一项范围综述，基于对科学数据库和灰色文献的系统检索，不受出版类型限制。根据综合护理分类法绘制关键信息并进行主题分析。对评估进行描述性分析。
纳入了来自五个国家与25个项目相关的79篇出版物。医疗保健概念通常是根据地区情况进行调整，以第三部门为基础，并采用跨部门方法。护理协调责任通常分配给高级执业护士，他们融入多专业项目团队。干预措施包括基于特殊需求的临床服务，以及护理协调、家庭护理支持和教育。对这些概念的评估很少，但现有结果表明对患者相关结果、护理协调、医疗保健利用和成本有有益影响。
文献中现有的概念往往描述不充分，且很少得到评估。需要研究它们对医疗保健质量和结果的影响。然而，已确定了几个关键特征，在为德国及其他地区的患者群体制定和实施综合且基于需求的方法时应予以考虑。
