Richards Ti-Amo DeRuz, Kirkham Julia, Lorenzetti Diane, Anderson Jennifer, Bahji Anees, Allami Youssef, Crockford David, Dyson Michele P, Ghosh Sumantra Monty, Hodgins David, Messier Geoffrey, Vik Shelly, Seitz Dallas P
Psychiatry, University of Calgary, Calgary, Alberta, Canada
Psychiatry, University of Calgary, Calgary, Alberta, Canada.
BMJ Open. 2025 Mar 29;15(3):e085216. doi: 10.1136/bmjopen-2024-085216.
Substance use disorders (SUDs) are a major public health challenge, affecting millions of individuals globally and contributing to substantial morbidity and mortality. Individuals with SUDs face numerous barriers to accessing high-quality healthcare, leaving vulnerable populations susceptible to the undertreatment of SUDs. Despite the availability of clinical practice guidelines and effective interventions for SUD, there is a notable gap in the implementation and adherence to evidence-based care.Measuring the quality of care (QoC) is a critical initial step toward enhancing the treatment and services provided to individuals with SUDs. While quality indicators (QIs) for SUD care have been established in various regions, including the USA, Canada and the UK, the application of QIs for the routine measurement of QoC for SUDs is not common. Identifying and characterising the areas of low QoC in SUD management can highlight critical targets for quality improvement initiatives. However, QoC measurement in SUD care is complex, with potentially redundant indicators derived from different sources, each with its own definitions, criteria and data requirements. This scoping review aims to explore the range of QIs that are currently available to assess the QoC for individuals with SUDs.
The review will follow the Arksey and O'Malley framework and incorporate methods proposed by the Joanna Briggs Institute (JBI) and Levac . Reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review guidelines (PRISMA). Stage 1: the research question will be identified, clarifying the purpose of the scoping review. Stage 2: six academic databases (Cochrane Library, Embase, CINAHL, Medline, APA PsycINFO and Scopus) and grey literature sources will be searched for studies reporting QIs and published from 1990 until 2023. Stage 3: study screening and selection will be completed by two reviewers independently to review titles, abstracts and full texts based on study inclusion criteria. Stage 4: a pilot data charting form has been developed to capture information from each study, including study design, population details, setting, methodology for QI development and reported QIs. Stage 5: data synthesis and consultation will employ thematic analysis and frequency counts to categorise identified QIs within established domains for quality of healthcare. Any discrepancies in data extraction or thematic synthesis will be identified and resolved using a third reviewer when necessary. A consultation exercise using a modified Delphi process will engage experts to prioritise identified QIs, aligning with JBI recommendations for stakeholder involvement in scoping reviews.
Patients and the public will not be directly involved in the design or conduct of this scoping review. However, stakeholder consultation, including individuals with lived experience of SUDs, will be incorporated during the Delphi process to prioritise identified QIs for SUD care.
Ethics approval is not necessary for stages 1-4 of this scoping review as it will not involve primary data collection. Ethics approval will be obtained from the University of Calgary Health Research Ethics Board prior to the commencement of stakeholder consultation (Stage 5) in January 2025. This scoping review was preregistered on the Open Science Framework. The results of this scoping review will be disseminated through peer-reviewed publications and conference presentations. Findings will be shared with local clinicians through presentations and with the research and clinical community at relevant conferences. This study represents a necessary first step towards establishing routine QoC measurement for SUDs. Results will be used in a stakeholder consensus exercise aimed at identifying key QIs for SUD care in Alberta, Canada, that will guide the future development of continuous QoC measurement using population-based data.
物质使用障碍（SUDs）是一项重大的公共卫生挑战，全球数百万人受其影响，并导致大量发病和死亡。患有物质使用障碍的个体在获得高质量医疗保健方面面临众多障碍，使弱势群体易患物质使用障碍治疗不足的问题。尽管有针对物质使用障碍的临床实践指南和有效干预措施，但在循证护理的实施和遵循方面仍存在显著差距。衡量护理质量（QoC）是提高为患有物质使用障碍的个体提供的治疗和服务的关键第一步。虽然包括美国、加拿大和英国在内的不同地区已经建立了物质使用障碍护理的质量指标（QIs），但将质量指标用于物质使用障碍护理质量的常规测量并不常见。识别和描述物质使用障碍管理中护理质量低的领域可以突出质量改进举措的关键目标。然而，物质使用障碍护理中的护理质量测量很复杂，不同来源可能有潜在冗余的指标，每个指标都有自己的定义、标准和数据要求。本范围综述旨在探讨目前可用于评估患有物质使用障碍的个体的护理质量的质量指标范围。
本综述将遵循阿克斯赛和奥马利框架，并纳入乔安娜·布里格斯研究所（JBI）和莱瓦克提出的方法。报告将遵循系统评价和元分析扩展的首选报告项目范围综述指南（PRISMA）。第1阶段：将确定研究问题，阐明范围综述的目的。第2阶段：将检索六个学术数据库（Cochrane图书馆、Embase、CINAHL、Medline、APA PsycINFO和Scopus）以及灰色文献来源，以查找报告质量指标并于1990年至2023年发表的研究。第3阶段：由两名评审员独立完成研究筛选和选择，根据研究纳入标准审查标题、摘要和全文。第4阶段：已制定一份试点数据图表表格，以从每项研究中获取信息，包括研究设计、人群详细信息、环境、质量指标开发方法和报告的质量指标。第5阶段：数据综合和咨询将采用主题分析和频数计数，将确定的质量指标在既定的医疗保健质量领域内进行分类。必要时，将使用第三位评审员识别并解决数据提取或主题综合中的任何差异。将使用改良的德尔菲法进行咨询活动，让专家对确定的质量指标进行优先排序，这与乔安娜·布里格斯研究所关于利益相关者参与范围综述的建议一致。
患者和公众不会直接参与本范围综述的设计或实施。然而，将在德尔菲过程中纳入利益相关者咨询，包括有物质使用障碍生活经历的个体，以便对确定的物质使用障碍护理质量指标进行优先排序。
本范围综述的第1 - 4阶段无需伦理批准，因为它不涉及原始数据收集。将在2025年1月利益相关者咨询（第5阶段）开始前从卡尔加里大学健康研究伦理委员会获得伦理批准。本范围综述已在开放科学框架上预先注册。本范围综述的结果将通过同行评审出版物和会议报告进行传播。研究结果将通过报告与当地临床医生分享，并在相关会议上与研究和临床社区分享。本研究是朝着为物质使用障碍建立常规护理质量测量迈出的必要第一步。结果将用于利益相关者共识活动，旨在确定加拿大艾伯塔省物质使用障碍护理的关键质量指标，这将指导未来使用基于人群的数据进行持续护理质量测量的发展。
