儿童和青少年特殊健康与保健需求的综合关怀：系统评价。
Integrated care for children and young people with special health and care needs: a systematic review.
机构信息
Department of Women & Children's Health, King's College London, London, UK
Department of Women & Children's Health, King's College London, London, UK.
出版信息
Arch Dis Child. 2024 Oct 18;109(11):924-931. doi: 10.1136/archdischild-2024-326905.
CONTEXT
There is a dearth of high-quality evidence on integrated, coordinated and cost-effective care for children with special health and care needs (CSHCN).
OBJECTIVE
To assess the effectiveness of integrated/coordinated care models for CSHCN.
DATA SOURCES
Embase, Ovid Medline(R), HMIC Health Management Information Consortium, Maternity & Infant Care Database (MIDIRS), PsycARTICLES, PsycINFO, Social Policy and Practice, Cochrane Central Register of Controlled Trials (CENTRAL), Global Health and PubMed.
STUDY SELECTION
Inclusion criteria comprised (1) randomised trials, including cluster randomised trials; (2) an integrated/coordinated care intervention; (3) for children and young people under 25 with special healthcare needs including medical complexity; (4) assessing child-centred outcomes, health-related quality of life among parents and carers, and health or social care use, processes of care and satisfaction with care.
DATA EXTRACTION
Data were extracted and assessed by two researchers, and descriptive data were synthesised according to outcome and intervention.
RESULTS
14 randomised controlled studies were included. Seven out of the 14 studies had a dedicated key worker/care coordinator as a vital part of the integrated/coordinated care intervention; however, the certainty of evidence for all outcomes was either 'low' or 'very low'.
LIMITATIONS
Included studies were mostly from high-income countries. Variable study outcomes and quality of evidence precluded meta-analysis.
CONCLUSIONS
Limited evidence favours integrated care for CSHCN using a dedicated key worker/care coordinator; however, heterogeneity in study outcomes and definitions of CSHCN limit the strength and utility of evidence obtained. Recommendations are made for improving integrated care practice, research and evaluation which are important for evidence-based health services for CSHCN.
PROSPERO REGISTRATION NUMBER
CRD42020209320.
背景
针对有特殊健康和照护需求的儿童（CSHCN）的综合、协调和具有成本效益的护理，高质量证据十分匮乏。
目的
评估 CSHCN 的综合/协调护理模式的效果。
数据来源
Embase、Ovid Medline(R)、HMIC 健康管理信息联合会、产妇和婴儿护理数据库（MIDIRS）、PsycARTICLES、PsycINFO、社会政策与实践、Cochrane 对照试验中心注册库（CENTRAL）、全球卫生和 PubMed。
研究选择
纳入标准包括：（1）随机试验，包括整群随机试验；（2）综合/协调护理干预；（3）针对 25 岁以下有特殊医疗需求（包括医疗复杂性）的儿童和青少年；（4）评估以儿童为中心的结果、父母和照顾者的健康相关生活质量、以及卫生或社会保健利用、护理过程和对护理的满意度。
数据提取
两名研究人员提取和评估了数据，并根据结果和干预措施对描述性数据进行了综合分析。
结果
纳入了 14 项随机对照研究。在这 14 项研究中，有 7 项研究将专门的关键工作者/护理协调员作为综合/协调护理干预的重要组成部分；然而，所有结局的证据确定性均为“低”或“极低”。
局限性
纳入的研究主要来自高收入国家。不同的研究结局和证据质量使得无法进行荟萃分析。
结论
有有限的证据支持使用专门的关键工作者/护理协调员为 CSHCN 提供综合护理；然而，研究结局和 CSHCN 定义的异质性限制了获得证据的强度和实用性。为改善 CSHCN 的综合护理实践、研究和评估提出了建议，这对于 CSHCN 的循证卫生服务非常重要。
PROSPERO 注册号：CRD42020209320。
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