Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
Medical Research Network, London, UK.
BMJ Open. 2023 Apr 4;13(4):e067441. doi: 10.1136/bmjopen-2022-067441.
This scoping review aimed to establish the approaches employed to improving patient safety in integrated care for community-dwelling adults with long-term conditions.
Scoping review.
All care settings.
Systematic searches of seven academic and grey literature databases for studies published between 2000 and 2021. At the full-text review stage both the first and second reviewer (SW) independently assessed full texts against the eligibility criteria and any discrepancies were discussed.
Overall, 24 studies were included in the review. Two key priorities for safety across care boundaries for adults with long-term conditions were falls and medication safety. Approaches for these priorities were implemented at different levels of an integrated care system. At the micro-level, approaches involved care primarily in the home setting provided by multi-disciplinary teams. At the meso-level, the focus was on planning and designing approaches at the managerial/organisational level to deliver multi-disciplinary care. At the macro-level, system-wide approaches included integrated care records, training and education and the development of care pathways involving multiple organisations. Across the included studies, evaluation of these approaches was undertaken using a wide range of process and outcome measures to capture patient harm and contributory factors associated with falls and medication safety.
For integrated care initiatives to fulfil their promise of improving care for adults with long-term conditions, approaches to improve patient safety need to be instituted across the system, at all levels to support the structural and relational aspects of integrated care as well as specific risk-related safety improvements.
本范围综述旨在确定在为社区居住的患有长期疾病的成年人提供综合护理中提高患者安全的方法。
范围综述。
所有护理环境。
系统检索了七个学术和灰色文献数据库，以查找 2000 年至 2021 年期间发表的研究。在全文审查阶段，第一和第二审查员（SW）独立根据资格标准评估全文，如果有任何差异，将进行讨论。
总体而言，有 24 项研究纳入了综述。对于患有长期疾病的成年人，跨越护理边界的两个关键安全重点是跌倒和用药安全。针对这些重点的方法在综合护理系统的不同层面上实施。在微观层面上，方法主要涉及多学科团队在家庭环境中提供的护理。在中观层面上，重点是在管理/组织层面规划和设计方法，以提供多学科护理。在宏观层面上，系统范围的方法包括综合护理记录、培训和教育以及涉及多个组织的护理路径的制定。在纳入的研究中，使用广泛的过程和结果措施来评估这些方法，以捕捉与跌倒和用药安全相关的患者伤害和促成因素。
为了使综合护理计划实现改善长期疾病患者护理的承诺，需要在整个系统中实施提高患者安全的方法，在所有层面上支持综合护理的结构和关系方面以及特定的与风险相关的安全改进。
