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基于网站的质量改进工具对卫生专业人员的实用性:系统评价。

The utility of website-based quality improvement tools for health professionals: a systematic review.

机构信息

Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia.

Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW 2502, Australia.

出版信息

Int J Qual Health Care. 2024 Jul 26;36(3). doi: 10.1093/intqhc/mzae068.

Abstract

As technology continues to advance, it is important to understand how website-based tools can support quality improvement. Website-based tools refer to resources such as toolkits that users can access and use autonomously through a dedicated website. This review examined how website-based tools can support healthcare professionals with quality improvement, including the optimal processes used to develop tools and the elements of an effective tool. A systematic search of seven databases was conducted to include articles published between January 2012 and January 2024. Articles were included if they were peer reviewed, written in English, based in health settings, and reported the development or evaluation of a quality improvement website-based tool for professionals. A narrative synthesis was conducted using NVivo. Risk of bias was assessed using the Mixed Methods Appraisal Tool. All papers were independently screened and coded by two authors using a six-phase conceptual framework by Braun and Clarke. Eighteen studies met the inclusion criteria. Themes identified were tool development processes, quality improvement mechanisms and barriers and facilitators to tool usage. Digitalizing existing quality improvement processes (n = 7), identifying gaps in practice (n = 6), and contributing to professional development (n = 3) were common quality improvement aims. Tools were associated with the reported enhancement of accuracy and efficiency in clinical tasks, improvement in adherence to guidelines, facilitation of reflective practice, and provision of tailored feedback for continuous quality improvement. Common features were educational resources (n = 7) and assisting the user to assess current practices against standards/recommendations (n = 6), which supported professionals in achieving better clinical outcomes, increased professional satisfaction and streamlined workflow in various settings. Studies reported facilitators to tool usage including relevance to practice, accessibility, and facilitating multidisciplinary action, making these tools practical and time-efficient for healthcare. However, barriers such as being time consuming, irrelevant to practice, difficult to use, and lack of organizational engagement were reported. Almost all tools were co-developed with stakeholders. The co-design approaches varied, reflecting different levels of stakeholder engagement and adoption of co-design methodologies. It is noted that the quality of included studies was low. These findings offer valuable insights for future development of quality improvement website-based tools in healthcare. Recommendations include ensuring tools are co-developed with healthcare professionals, focusing on practical usability and addressing common barriers to enhance engagement and effectiveness in improving healthcare quality. Randomized controlled trials are warranted to provide objective evidence of tool efficacy.

摘要

随着技术的不断进步,了解网站工具如何支持质量改进变得尤为重要。网站工具是指用户可以通过专用网站自主访问和使用的资源,例如工具包。本综述考察了网站工具如何支持医疗保健专业人员进行质量改进,包括用于开发工具的最佳流程以及有效工具的要素。通过对七个数据库进行系统搜索,纳入了 2012 年 1 月至 2024 年 1 月期间发表的文章。纳入的文章需要经过同行评审、用英语撰写、基于卫生环境,并报告开发或评估专业人员使用的基于网站的质量改进工具。使用 NVivo 进行叙述性综合。使用混合方法评估工具评估偏倚风险。所有论文均由两位作者独立筛选和编码,使用 Braun 和 Clarke 的六阶段概念框架。有 18 项研究符合纳入标准。确定的主题包括工具开发过程、质量改进机制以及工具使用的障碍和促进因素。将质量改进过程数字化(n=7)、确定实践中的差距(n=6)和促进专业发展(n=3)是常见的质量改进目标。工具与报告中临床任务准确性和效率的提高、对指南的遵守的改善、促进反思性实践以及提供持续质量改进的定制反馈有关。常见的特征是教育资源(n=7)和帮助用户将当前实践与标准/建议进行比较(n=6),这有助于专业人员实现更好的临床结果、提高专业满意度并简化各种环境中的工作流程。报告中还提到了工具使用的促进因素,包括与实践相关、可及性和促进多学科行动,使这些工具在医疗保健方面具有实用性和高效性。然而,也报告了一些障碍,例如耗时、与实践无关、难以使用以及缺乏组织参与。几乎所有工具都是与利益相关者共同开发的。联合设计方法各不相同,反映了不同程度的利益相关者参与和采用联合设计方法。值得注意的是,纳入研究的质量较低。这些研究结果为未来医疗保健中基于网站的质量改进工具的开发提供了有价值的见解。建议包括确保工具与医疗保健专业人员共同开发,注重实际可用性,并解决常见障碍,以提高工具在提高医疗质量方面的参与度和效果。需要进行随机对照试验以提供工具疗效的客观证据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6a00/11277856/51c370727979/mzae068f1.jpg

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