Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.
School of Health Sciences and Social Work, Griffith University, Gold Coast, Campus, QLD, Australia.
J Hum Nutr Diet. 2022 Jun;35(3):479-493. doi: 10.1111/jhn.12963. Epub 2021 Nov 25.
Quality improvement strategies have been widely applied in health care; however, little is known about their use in primary care dietetics. This review aims to describe and evaluate the effectiveness of quality improvement strategies that seek to improve patient outcomes by enhancing dietetic care compared to standard dietetic care.
The study employed a systematic review and meta-analysis design following PRISMA guidelines and included studies up to March 2021. Studies were included if they used a randomised controlled trial (RCT) design to evaluate the effect of a quality improvement strategy applied to care delivered by a dietitian on patient outcomes. A meta-analysis was conducted where there were sufficient studies with homogeneous populations and outcome measures.
Twelve RCTs (n = 1604) met the inclusion criteria for review and five studies (n = 511) were eligible for meta-analysis for glycated haemoglobin in patients with type 2 diabetes. The most frequently reported quality improvement strategies addressed disease management programs (58%), patient education (67%), group care (42%) and patient self-management (42%). A positive intervention effect was reported in 50% of the included studies. A low grade of evidence supported a positive intervention effect for quality improvement intervention by a dietitian for glycated haemoglobin (pooled mean difference = -0.39% with 95% confidence interval = -0.70 to -0.08, p = 0.01) in n = 511 patients with type 2 diabetes mellitus.
Interventions aimed at enhancing quality in primary care dietetic practice support improvements in patient outcomes. Further research on quality improvement interventions for patient outcomes is required to strengthen the evidence base in this important topic.
质量改进策略已在医疗保健领域广泛应用；然而，对于在初级保健营养师中使用这些策略的情况知之甚少。本综述旨在描述和评估旨在通过加强营养师护理来改善患者结局的质量改进策略的有效性，与标准营养师护理相比。
该研究采用了系统综述和荟萃分析设计，遵循 PRISMA 指南，并纳入了截至 2021 年 3 月的研究。如果研究使用随机对照试验（RCT）设计来评估应用于营养师提供的护理的质量改进策略对患者结局的影响，则纳入研究。如果有足够的具有同质人群和结局测量的研究，则进行荟萃分析。
符合综述标准的 12 项 RCT（n=1604）和 5 项研究（n=511）符合荟萃分析条件，用于 2 型糖尿病患者的糖化血红蛋白。报道最多的质量改进策略是疾病管理方案（58%）、患者教育（67%）、小组护理（42%）和患者自我管理（42%）。纳入的研究中有 50%报告了积极的干预效果。低质量证据支持营养师的质量改进干预对糖化血红蛋白（n=511 例 2 型糖尿病患者的汇总平均差异=-0.39%，95%置信区间=-0.70 至-0.08，p=0.01）有积极的干预效果。
旨在提高初级保健营养师实践质量的干预措施支持改善患者结局。需要进一步研究患者结局的质量改进干预措施，以加强这一重要主题的证据基础。
