理解审核如何以及为何能改善医院护理质量：系统的现实主义综述。
Understanding how and why audits work in improving the quality of hospital care: A systematic realist review.
机构信息
Centre of Expertise on Quality and Safety, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Department Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands.
出版信息
PLoS One. 2021 Mar 31;16(3):e0248677. doi: 10.1371/journal.pone.0248677. eCollection 2021.
BACKGROUND
Several types of audits have been used to promote quality improvement (QI) in hospital care. However, in-depth studies into the mechanisms responsible for the effectiveness of audits in a given context is scarce. We sought to understand the mechanisms and contextual factors that determine why audits might, or might not, lead to improved quality of hospital care.
METHODS
A realist review was conducted to systematically search and synthesise the literature on audits. Data from individual papers were synthesised by coding, iteratively testing and supplementing initial programme theories, and refining these theories into a set of context-mechanism-outcome configurations (CMOcs).
RESULTS
From our synthesis of 85 papers, seven CMOcs were identified that explain how audits work: (1) externally initiated audits create QI awareness although their impact on improvement diminishes over time; (2) a sense of urgency felt by healthcare professionals triggers engagement with an audit; (3) champions are vital for an audit to be perceived by healthcare professionals as worth the effort; (4) bottom-up initiated audits are more likely to bring about sustained change; (5) knowledge-sharing within externally mandated audits triggers participation by healthcare professionals; (6) audit data support healthcare professionals in raising issues in their dialogues with those in leadership positions; and (7) audits legitimise the provision of feedback to colleagues, which flattens the perceived hierarchy and encourages constructive collaboration.
CONCLUSIONS
This realist review has identified seven CMOcs that should be taken into account when seeking to optimise the design and usage of audits. These CMOcs can provide policy makers and practice leaders with an adequate conceptual grounding to design contextually sensitive audits in diverse settings and advance the audit research agenda for various contexts.
PROSPERO REGISTRATION
CRD42016039882.
背景
已有多种类型的审核被用于促进医院护理质量的提升（QI）。然而，在特定背景下，针对审核有效性的作用机制进行深入研究却十分匮乏。我们旨在了解决定审核在何种情况下可能会或可能不会导致医院护理质量提升的机制和情境因素。
方法
我们进行了一项真实主义综述，以系统地搜索和综合有关审核的文献。通过对初始方案理论进行编码、迭代测试和补充，并将这些理论精炼为一系列情境-机制-结果组态（CMOcs），对来自各个论文的数据进行综合。
结果
通过对 85 篇论文的综合分析，我们确定了七种解释审核如何发挥作用的 CMOcs：（1）外部发起的审核会产生 QI 意识，尽管其对改进的影响会随时间逐渐减弱；（2）医疗保健专业人员感受到的紧迫感会促使他们参与审核；（3）拥护者对于审核被医疗保健专业人员视为值得努力的关键；（4）自下而上发起的审核更有可能带来持续的变革；（5）在强制进行的审核中进行知识共享会激发医疗保健专业人员的参与；（6）审核数据支持医疗保健专业人员在与领导层的对话中提出问题；（7）审核使向同事提供反馈合理化，这会拉平感知到的层级，鼓励建设性的合作。
结论
本真实主义综述确定了七个 CMOcs，在寻求优化审核的设计和使用时应予以考虑。这些 CMOcs 可以为决策者和实践领导者提供充分的概念基础，以便在不同背景下设计具有情境敏感性的审核，并推进不同背景下的审核研究议程。
PROSPERO 注册号：CRD42016039882。
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