Contandriopoulos Damien, Stajduhar Kelli, Sanders Tanya, Carrier Annie, Bitschy Ami, Funk Laura
School of Nursing, University of Victoria, Victoria, British-Columbia, Canada.
Institute on Aging and Lifelong Health, University of Victoria, Victoria, British-Columbia, Canada.
J Eval Clin Pract. 2022 Aug;28(4):680-689. doi: 10.1111/jep.13627. Epub 2021 Oct 6.
RATIONALE, AIMS AND OBJECTIVES: There is a large body of literature from all over the world that describes, analyzes, or evaluates home care models and interventions. The present article aims to identify the practical lessons that can be gained from a systematic examination of that literature.
We conducted a three-step sequential search process from which 113 documents were selected. That corpus was then narratively analysed according to a realist review approach.
A first level of observation is that there are multiple blind spots in the existing literature on home care. The definition and delimitation of what constitutes home care services is generally under-discussed. In the same way, the composition of the basket of care provided and its fit with the need of recipients is under-addressed. Finally, the literature relies heavily on RCTs whose practical contribution to decisions or policy is disputable. At a second level, our analysis suggests that three mechanisms (system integration, case management and relational continuity) are core characteristics of home care models' effectiveness.
We conclude by providing advice for supporting the design and implementation of stronger home care delivery systems. Our analysis suggests that doing so implies a series of sequential steps: identify what system-level goals the model should achieve and which populations it should serve; identify what type of services are likely to achieve those goals in order to establish a basket of services; and finally, identify the best ways and specific means to effectively and efficiently provide those services. Those same steps can also support ex-post evaluations of existing home care systems.
原理、目的与目标：来自世界各地的大量文献描述、分析或评估了家庭护理模式与干预措施。本文旨在确定通过对该文献进行系统审视能够获得的实践经验教训。
我们开展了一个三步连续检索过程，从中选取了113篇文献。然后根据实证主义综述方法对该文献库进行了叙述性分析。
第一个层面的观察结果是，现有家庭护理文献存在多个盲点。家庭护理服务的构成定义与界定通常讨论不足。同样，所提供护理组合的构成及其与接受者需求的契合度也未得到充分探讨。最后，文献严重依赖随机对照试验，其对决策或政策的实际贡献存在争议。在第二个层面，我们的分析表明，三种机制（系统整合、病例管理和关系连续性）是家庭护理模式有效性的核心特征。
我们通过为支持更强有力的家庭护理提供系统的设计与实施提供建议来得出结论。我们的分析表明，这样做意味着一系列连续步骤：确定该模式应实现的系统层面目标以及应服务的人群；确定哪些类型的服务可能实现这些目标，以便建立一套服务组合；最后，确定有效且高效提供这些服务的最佳方式和具体手段。这些相同步骤也可支持对现有家庭护理系统的事后评估。
