基层医疗中心血管疾病一级预防的质量指标：一项系统评价。
Quality indicators for the primary prevention of cardiovascular disease in primary care: A systematic review.
作者信息
Bam Kiran, Olaiya Muideen T, Cadilhac Dominique A, Redfern Julie, Nelson Mark R, Sanders Lauren M, Sundararajan Vijaya, Andrew Nadine E, Murphy Lisa, Kilkenny Monique F
机构信息
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia.
出版信息
PLoS One. 2024 Dec 5;19(12):e0312137. doi: 10.1371/journal.pone.0312137. eCollection 2024.
BACKGROUND
Primary care is usually the entry point for preventing cardiovascular disease (CVD). Quality indicators can be used to assess and monitor the quality of care provided in a primary care setting. In this systematic review, we aimed to identify, summarise, and assess the methodological quality of indicators reported in the articles for the primary prevention of CVD in primary care.
METHODS
We searched Ovid MEDLINE, Ovid EMBASE, CINAHL Plus, SCOPUS, and grey literature for articles containing quality indicators published in English language. Quality indicators were categorised using the Donabedian framework: Structure (organisation of care), Process (assessment of metabolic risk factors, global risk assessment, lifestyle management, prescription of medications, risk communication/advice, referral), and Outcome (attainment of risk factor targets). Articles were reviewed by two authors, using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument, where a score of ≥50% for each domain indicated strong methodological quality (e.g., stakeholder involvement).
RESULTS
We identified 282 articles for full-text review; 57 articles were included for extraction. A total of 726 (681 unique) quality indicators were extracted. Three out of four (76%) were process indicators (56 articles), followed by 15% outcome indicators (40 articles), and 9% structure indicators (12 articles). One-third of process indicators were related to the assessment of metabolic risk factors (222/726 indicators, 41 articles), followed by lifestyle management (153/726 indicators, 39 articles), prescription of medications (122/726 indicators, 37 articles), and global risk assessment (27/726, 14 articles). Few indicators were related to risk communication/advice (20/726 indicators, 7 articles) and referral (9/726 indicators, 6 articles). Only 26/57 (46%) articles were found to have strong methodological quality.
CONCLUSION
We summarised and appraised the methodological quality of indicators for the primary prevention of CVD. The next step requires prioritising a minimum set of quality indicators to encourage standardised collection and monitoring across countries.
背景
初级保健通常是预防心血管疾病（CVD）的切入点。质量指标可用于评估和监测初级保健机构所提供的护理质量。在本系统评价中，我们旨在识别、总结并评估初级保健中关于CVD一级预防的文章所报告指标的方法学质量。
方法
我们在Ovid MEDLINE、Ovid EMBASE、CINAHL Plus、SCOPUS以及灰色文献中检索以英文发表的包含质量指标的文章。使用Donabedian框架对质量指标进行分类：结构（护理组织）、过程（代谢危险因素评估、总体风险评估、生活方式管理、药物处方、风险沟通/建议、转诊）和结果（危险因素目标的达成）。由两位作者使用“通过研究与评估对指标进行评价”（AIRE）工具对文章进行评审，每个领域得分≥50%表明方法学质量较高（例如，有利益相关者参与）。
结果
我们确定了282篇文章进行全文评审；纳入57篇文章进行指标提取。共提取了726个（681个不同的）质量指标。四分之三（76%）是过程指标（56篇文章），其次是15%的结果指标（40篇文章）和9%的结构指标（12篇文章）。三分之一的过程指标与代谢危险因素评估有关（222/726个指标，41篇文章），其次是生活方式管理（153/726个指标，39篇文章）、药物处方（122/726个指标，37篇文章）和总体风险评估（27/726，14篇文章）。与风险沟通/建议（20/726个指标，7篇文章）和转诊（9/726个指标，6篇文章）相关的指标很少。仅26/57（46%）篇文章的方法学质量较高。
结论
我们总结并评估了CVD一级预防指标的方法学质量。下一步需要对一组最低限度的质量指标进行优先排序，以鼓励各国进行标准化的数据收集和监测。
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