长期护理机构中提高指南依从性的倡导者：一项系统综述
Champions for improved adherence to guidelines in long-term care homes: a systematic review.
作者信息
Hall Amanda M, Flodgren Gerd M, Richmond Helen L, Welsh Sheila, Thompson Jacqueline Y, Furlong Bradley M, Sherriff Andrea
机构信息
Primary Healthcare Research Unit (PHRU), Faculty of Medicine, Memorial University of Newfoundland, Janeway Hostel, Health Sciences Centre, 300 Prince Philip Parkway, St. John's, NL, A1B 3 V6, Canada.
Division for Health Services, Norwegian Institute of Public Health, Marcus Thranes gate 6, Oslo, 0403, Norway.
出版信息
Implement Sci Commun. 2021 Aug 3;2(1):85. doi: 10.1186/s43058-021-00185-y.
BACKGROUND
The champion model is increasingly being adopted to improve uptake of guideline-based care in long-term care (LTC). Studies suggest that an on-site champion may improve the quality of care residents' health outcomes. This review assessed the effectiveness of the champion on staff adherence to guidelines and subsequent resident outcomes in LTC homes.
METHOD
This was a systematic review and meta-analyses of randomised controlled trials. Eligible studies included residents aged 65 or over and nursing staff in LTC homes where there was a stand-alone or multi-component intervention that used a champion to improve staff adherence to guidelines and resident outcomes. The measured outcomes included staff adherence to guidelines, resident health outcomes, quality of life, adverse events, satisfaction with care, or resource use. Study quality was assessed with the Cochrane Risk of Bias tool; evidence certainty was assessed using the GRADE approach.
RESULTS
After screening 4367 citations, we identified 12 articles that included the results of 1 RCT and 11 cluster-RCTs. All included papers evaluated the effects of a champion as part of a multicomponent intervention. We found low certainty evidence that champions as part of multicomponent interventions may improve staff adherence to guidelines. Effect sizes varied in magnitude across studies including unadjusted risk differences (RD) of 4.1% [95% CI: - 3%, 9%] to 44.8% [95% CI: 32%, 61%] for improving pressure ulcer prevention in a bed and a chair, respectively, RD of 44% [95% CI: 17%, 71%] for improving depression identification and RD of 21% [95% CI: 12%, 30%] for improving function-focused care to residents.
CONCLUSION
Champions may improve staff adherence to evidence-based guidelines in LTC homes. However, methodological issues and poor reporting creates uncertainty around these findings. It is premature to recommend the widespread use of champions to improve uptake of guideline-based care in LTC without further study of the champion role and its impact on cost.
TRIAL REGISTRATION
PROSPERO CRD42019145579 . Registered on 20 August 2019.
背景
冠军模式越来越多地被用于提高长期护理（LTC）中基于指南的护理的采用率。研究表明，现场冠军可能会改善居民护理质量和健康结果。本综述评估了冠军对长期护理机构中工作人员遵循指南情况以及随后居民结局的有效性。
方法
这是一项对随机对照试验的系统综述和荟萃分析。符合条件的研究包括65岁及以上的居民和长期护理机构中的护理人员，在这些机构中存在单独或多成分干预措施，使用冠军来提高工作人员对指南的遵循情况和居民结局。测量的结局包括工作人员对指南的遵循情况、居民健康结局、生活质量、不良事件、护理满意度或资源使用情况。使用Cochrane偏倚风险工具评估研究质量；使用GRADE方法评估证据确定性。
结果
在筛选了4367篇文献后，我们确定了12篇文章，其中包括1项随机对照试验（RCT）和11项整群随机对照试验（cluster-RCT）的结果。所有纳入的论文都评估了冠军作为多成分干预措施一部分的效果。我们发现低确定性证据表明，作为多成分干预措施一部分的冠军可能会提高工作人员对指南的遵循情况。各研究中的效应量大小不同，例如在预防卧床和坐椅压力性溃疡方面，未调整的风险差异（RD）分别为4.1%[95%置信区间：-3%，9%]至44.8%[95%置信区间：32%，61%]；在改善抑郁症识别方面，RD为44%[95%置信区间：17%，71%]；在改善针对居民的功能导向护理方面，RD为21%[95%置信区间：12%，30%]。
结论
冠军可能会提高长期护理机构中工作人员对循证指南的遵循情况。然而，方法学问题和报告不佳使得这些研究结果存在不确定性。在没有进一步研究冠军角色及其对成本的影响之前，建议在长期护理中广泛使用冠军来提高基于指南的护理的采用率还为时过早。
试验注册
PROSPERO CRD42019145579。于2019年8月20日注册。
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