Keen Justin, Abdulwahid Maysam Ali, King Natalie, Wright Judy M, Randell Rebecca, Gardner Peter, Waring Justin, Longo Roberta, Nikolova Silviya, Sloan Claire, Greenhalgh Joanne
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
BMJ Open. 2020 Oct 10;10(10):e036608. doi: 10.1136/bmjopen-2019-036608.
Health services in many countries are investing in interorganisational networks, linking patients' records held in different organisations across a city or region. The aim of the systematic review was to establish how, why and in what circumstances these networks improve patient safety, fail to do so, or increase safety risks, for people living at home.
Realist synthesis, drawing on both quantitative and qualitative evidence, and including consultation with stakeholders in nominal groups and semistructured interviews.
The coordination of services for older people living at home, and medicine reconciliation for older patients returning home from hospital.
17 sources including Medline, Embase, CINAHL, Cochrane Library, Web of Science, ACM Digital Library, and Applied Social Sciences Index and Abstracts.
Changes in patients' clinical risks.
We did not find any detailed accounts of the sequences of events that policymakers and others believe will lead from the deployment of interoperable networks to improved patient safety. We were, though, able to identify a substantial number of theory fragments, and these were used to develop programme theories.There is good evidence that there are problems with the coordination of services in general, and the reconciliation of medication lists in particular, and it indicates that most problems are social and organisational in nature. There is also good evidence that doctors and other professionals find interoperable networks difficult to use. There was limited high-quality evidence about safety-related outcomes associated with the deployment of interoperable networks.
Empirical evidence does not currently justify claims about the beneficial effects of interoperable networks on patient safety. There appears to be a mismatch between technology-driven assumptions about the effects of networks and the sociotechnical nature of coordination problems.
CRD42017073004.
许多国家的卫生服务机构正在投资建立组织间网络，将城市或地区内不同组织所保存的患者记录连接起来。本系统评价的目的是确定这些网络如何、为何以及在何种情况下能改善居家患者的安全状况、未能做到这一点或增加安全风险。
基于实证的综合分析，借鉴定量和定性证据，并包括与名义小组和半结构化访谈中的利益相关者进行磋商。
为居家老年人提供服务的协调，以及医院出院回家的老年患者的用药核对。
17个来源，包括医学期刊数据库（Medline）、荷兰医学文摘数据库（Embase）、护理学与健康领域数据库（CINAHL）、考克兰图书馆、科学引文索引数据库（Web of Science）、美国计算机协会数字图书馆以及应用社会科学索引与摘要数据库。
我们未找到任何关于政策制定者及其他人员认为可从部署可互操作网络到改善患者安全的事件序列的详细描述。不过，我们能够识别出大量理论片段，并将其用于构建项目理论。有充分证据表明，总体上服务协调存在问题，尤其是用药清单核对方面，且表明大多数问题本质上是社会和组织层面的。也有充分证据表明医生和其他专业人员发现可互操作网络难以使用。关于与部署可互操作网络相关的安全相关结果的高质量证据有限。
目前实证证据无法证明关于可互操作网络对患者安全有益影响的说法合理。技术驱动的关于网络效果的假设与协调问题的社会技术性质之间似乎存在不匹配。
国际系统评价注册平台（PROSPERO）注册号：CRD42017073004。
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