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中国医院团队合作知多少?系统评价。

What Do We Know About Teamwork in Chinese Hospitals? A Systematic Review.

机构信息

Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.

Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Front Public Health. 2021 Dec 17;9:735754. doi: 10.3389/fpubh.2021.735754. eCollection 2021.


DOI:10.3389/fpubh.2021.735754
PMID:34976910
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8719585/
Abstract

Improving quality of care is one of the primary goals in current Chinese hospital reforms. Teamwork can play an essential role. Characteristics of teamwork and interventions for improving teamwork in hospitals have been widely studied. However, most of these studies are from a Western context; evidence from China is scarce. Because of the contextual differences between China and Western countries, empirical evidence on teamwork from Western hospitals may have limited validity in China. This systematic review aims to advance the evidence base and understanding of teamwork in Chinese hospitals. Both English (i.e., Embase, Medline, and Web of Science) and Chinese databases (i.e., CNKI, CQVIP, and Wanfang) were searched for relevant articles until February 6, 2020. We included the studies that empirically researched teamwork in Chinese hospitals. Studies were excluded if they (1) were not conducted in hospitals in Mainland China, (2) did not research teamwork on team interventions, (3) were not empirical, (4) were not written in English or Chinese, (5) were not published in peer-reviewed journals, and (6) were not conducted in teams that provide direct patient care. Both deductive and inductive approaches were used to analyze data. The Mixed Methods Appraisal Tool (MMAT) was used to assess their methodological quality. A total of 70 articles (i.e., 39 English articles and 31 Chinese articles) were included. The results are presented in two main categories: Teamwork components and Team interventions. The evidence regarding the relationships among inputs, processes, and outcomes is scarce and mostly inconclusive. The only conclusive evidence shows that females perceive better team processes than males. Similar types of training and tools were introduced as can be found in Western literature, all showing positive effects. In line with the Chinese health reforms, many of the intervention studies regard the introduction of multidisciplinary teams (MDTs). The evidence on the implementation of MDTs reveals that they have led to lower complication rates, shorter hospital stays, higher diagnosis accuracy, efficiency improvement, and a variety of better disease-specific clinical outcomes. Evidence on the effect on patient survival is inconclusive. The Chinese studies on teamwork components mainly focus on the input-process relationship. The evidence provided on this relationship is, however, mostly inconclusive. The intervention studies in Chinese hospitals predominantly focus on patient outcomes rather than organizational and employee outcomes. The introduction of training, tools, and MDTs generally shows promising results. The evidence from primary hospitals and rural areas, which are prioritized in the health reforms, is especially scarce. Advancing the evidence base on teamwork, especially in primary hospitals and rural areas, is needed and can inform policy and management to promote the health reform implementation. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020175069, identifier CRD42020175069.

摘要

提高医疗质量是当前中国医院改革的主要目标之一。团队合作可以发挥重要作用。团队合作的特点和改善医院团队合作的干预措施已得到广泛研究。然而,这些研究大多来自西方背景;来自中国的证据很少。由于中西方之间的背景差异,西方医院的团队合作经验证据在中国可能有效性有限。本系统评价旨在推进中国医院团队合作的证据基础和理解。同时检索了英文数据库(即 Embase、Medline 和 Web of Science)和中文数据库(即 CNKI、CQVIP 和万方),以获取相关文章,检索截至 2020 年 2 月 6 日。我们纳入了在中国医院进行团队合作实证研究的研究。如果研究(1)不是在中国大陆的医院进行的,(2)没有研究团队干预措施的团队合作,(3)不是实证研究,(4)不是英文或中文撰写的,(5)不是在同行评议期刊上发表的,以及(6)不是在提供直接患者护理的团队中进行的,则将其排除在外。采用演绎法和归纳法分析数据。使用混合方法评估工具(MMAT)评估其方法学质量。共纳入 70 篇文章(即 39 篇英文文章和 31 篇中文文章)。结果分为两个主要类别:团队组成部分和团队干预措施。关于投入、过程和结果之间关系的证据很少,而且大多没有定论。唯一有定论的证据表明,女性比男性感知到更好的团队过程。引入了与西方文献中类似的培训类型和工具,都显示出积极的效果。与中国卫生改革相一致,许多干预研究都涉及多学科团队(MDT)的引入。MDT 实施的证据表明,MDT 导致了更低的并发症发生率、更短的住院时间、更高的诊断准确率、效率提高以及各种更好的特定疾病临床结果。关于对患者生存影响的证据尚无定论。中国关于团队组成部分的研究主要集中在投入-过程关系上。然而,提供的关于这种关系的证据大多没有定论。中国医院的干预研究主要关注患者的结局,而不是组织和员工的结局。培训、工具和 MDT 的引入通常显示出有希望的结果。初级医院和农村地区的证据(在卫生改革中优先考虑)尤其缺乏。需要推进团队合作方面的证据基础,特别是在初级医院和农村地区,这可以为政策和管理提供信息,以促进卫生改革的实施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2681/8719585/b69782942cc3/fpubh-09-735754-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2681/8719585/b69782942cc3/fpubh-09-735754-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2681/8719585/b69782942cc3/fpubh-09-735754-g0001.jpg

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[1]
The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.

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[2]
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Front Oncol. 2020-3-20

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