Liu Beixue, Cai Jingyi, Zhou Lanshu
Department of Nursing Clinical Nursing Teaching and Research, Naval Medical University, Shanghai, China.
Key Laboratory of Geriatric Long-Term Care (Naval Medical University), Ministry of Education, Shanghai, China.
J Nurs Scholarsh. 2025 Mar;57(2):266-297. doi: 10.1111/jnu.13027. Epub 2024 Sep 24.
Given that stroke is a leading cause of disability and mortality worldwide, there is an urgent need for a coordinated healthcare approach to mitigate its effects. The objectives of this study were to perform a systematic review and meta-analysis of stroke integrated care models and develop recommendations for a representative model.
A systematic review and meta-analysis.
The literature search identified randomized controlled trials comparing integrated care models with standard care for stroke patients. The included studies followed PICOs inclusion criteria. The qualitative analysis included creating a flowchart for the literature screening process, and tables detailing the basic characteristics of the included studies, the adherence to the ten principles and the results of the quality assessments. Subsequently, quantitative meta-analytical procedures were conducted to statistically pool the data and quantify the effects of the integrated care models on stroke patients' health-related quality of life, activities of daily living, and depression. The China National Knowledge Infrastructure (CNKI), Wanfang Data, Chongqing VIP Chinese Science and Technology Periodical Database (VIP), China Biology Medicine Disc (CBMDISC), Cochrane Library, Cumulated Index to Nursing and Allied Health Literature (CINAHL), PubMed, Web of Science, Embase, Google Scholar, and Clinical Trials were searched from inception to March 13, 2024.
Of the 2547 obtained articles, 19 were systematically reviewed and 15 were included in the meta-analysis. The integrated care models enhanced stroke patients' health-related quality of life, ability to perform activities of daily living, and reduced depression. Adherence to the 10 principles varied: comprehensive services, patient focus, and standardized care delivery had strong implementation, while gaps were noted in geographic coverage, information systems, governance structures, and financial management.
Integrated care models improve outcomes for stroke patients and adherence to the 10 principles is vital for their implementation success. This study's findings call for a more standardized approach to implementing integrated care models, emphasizing the need for integrated services, patient-centred care, and interdisciplinary collaboration, while also addressing the identified gaps in terms of integration efforts.
This study provides evidence-based recommendations on the most effective integrated care approaches for stroke patients, potentially leading to better patient outcomes, reduced healthcare costs, and improved quality of life.
鉴于中风是全球残疾和死亡的主要原因，迫切需要一种协调一致的医疗保健方法来减轻其影响。本研究的目的是对中风综合护理模式进行系统评价和荟萃分析，并为代表性模式制定建议。
系统评价和荟萃分析。
文献检索确定了比较中风患者综合护理模式与标准护理的随机对照试验。纳入的研究遵循PICOs纳入标准。定性分析包括创建文献筛选过程的流程图，以及详细列出纳入研究基本特征、对十项原则的遵守情况和质量评估结果的表格。随后，进行定量荟萃分析程序，以统计汇总数据并量化综合护理模式对中风患者健康相关生活质量、日常生活活动和抑郁的影响。检索了中国知网（CNKI）、万方数据、重庆维普中文科技期刊数据库（VIP）、中国生物医学文献数据库（CBMDISC）、考克兰图书馆、护理及相关健康文献累积索引（CINAHL）、PubMed、科学引文索引（Web of Science）、Embase、谷歌学术和临床试验数据库，检索时间从建库至2024年3月13日。
在获得的2547篇文章中，19篇进行了系统评价，15篇纳入荟萃分析。综合护理模式提高了中风患者的健康相关生活质量、日常生活活动能力，并减轻了抑郁。对十项原则的遵守情况各不相同：全面服务、以患者为中心和标准化护理提供方面的实施力度较大，而在地理覆盖范围、信息系统、治理结构和财务管理方面存在差距。
综合护理模式改善了中风患者的预后，遵守十项原则对其实施成功至关重要。本研究结果呼吁采用更标准化的方法来实施综合护理模式，强调需要综合服务、以患者为中心的护理和跨学科合作，同时也需要解决在整合工作方面发现的差距。
本研究为中风患者最有效的综合护理方法提供了循证建议，可能会带来更好的患者预后、降低医疗成本并提高生活质量。
