Abstract：
BACKGROUND: Patients receiving home enteral tube feeding (HETF) have a high risk of complications and readmission to hospital. This study aims to evaluate effectiveness of staff- and/or patient-focused service-improvement strategies on clinical, patient-reported, and economic outcomes for patients receiving HETF across adult settings.
METHODS: The search was conducted using MEDLINE, EMBASE, and CINAHL databases. Quality of studies were appraised using the Cochrane Collaboration Risk of Bias tool and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment.
RESULTS: Eleven studies met the inclusion criteria. Pooled data found targeted HETF education with patients, carers, and staff significantly improved knowledge immediately after education and was sustained at 3-6 months. Multimodal interventions, including the formation of specialist HETF teams, significantly reduced complications such as infection, gastrostomy blockage, tube displacement, and feed intolerance but do not significantly reduce unplanned hospital encounters (outpatient clinic visits, hospitalizations, and emergency presentations). Owing to the high risk of bias in the included studies, there is low-quality evidence to support staff training, patient education, and dedicated HETF teams.
CONCLUSIONS: This review highlights the need for further quality research to allow higher-level evidence for determining the usefulness of interventions aimed at improving outcomes for patients receiving HETF. Future research needs to include greater assessment of quality of life, quantification of the value of interventions in economic terms, and use of translational research frameworks. However, effective staff and patient education programs, along with comprehensive multidisciplinary care, should be considered standard care until a larger research base is developed.
METHODS: The search was conducted using MEDLINE, EMBASE, and CINAHL databases. Quality of studies were appraised using the Cochrane Collaboration Risk of Bias tool and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment.
RESULTS: Eleven studies met the inclusion criteria. Pooled data found targeted HETF education with patients, carers, and staff significantly improved knowledge immediately after education and was sustained at 3-6 months. Multimodal interventions, including the formation of specialist HETF teams, significantly reduced complications such as infection, gastrostomy blockage, tube displacement, and feed intolerance but do not significantly reduce unplanned hospital encounters (outpatient clinic visits, hospitalizations, and emergency presentations). Owing to the high risk of bias in the included studies, there is low-quality evidence to support staff training, patient education, and dedicated HETF teams.
CONCLUSIONS: This review highlights the need for further quality research to allow higher-level evidence for determining the usefulness of interventions aimed at improving outcomes for patients receiving HETF. Future research needs to include greater assessment of quality of life, quantification of the value of interventions in economic terms, and use of translational research frameworks. However, effective staff and patient education programs, along with comprehensive multidisciplinary care, should be considered standard care until a larger research base is developed.
摘要：
背景：接受家庭肠内营养（HETF）的患者发生并发症和再次入院的风险很高。本研究旨在评估以员工和/或患者为中心的服务改进策略对临床，患者报告，以及在成人环境中接受HETF的患者的经济结果。
方法：使用MEDLINE进行搜索，EMBASE,和CINAHL数据库。使用Cochrane协作偏差风险工具和建议评估分级评估来评估研究质量，发展,和评估（等级）评估。
结果：11项研究符合纳入标准。汇总数据发现有针对性的HETF对患者进行教育，看护者,员工在接受教育后立即显著提高了知识水平，并在3-6个月内持续。多式联运干预，包括组建专业的HETF团队，显着减少并发症，如感染，胃造口术阻塞,管位移,和饲料不耐受，但不能显著减少计划外的医院接触(门诊就诊，住院治疗,和紧急演示)。由于纳入研究的偏倚风险较高，有低质量的证据来支持员工培训，患者教育,和专门的HETF团队。
结论：这篇综述强调了需要进一步的高质量研究，以允许更高水平的证据来确定旨在改善接受HETF患者预后的干预措施的有效性。未来的研究需要包括对生活质量的更多评估，从经济角度量化干预措施的价值，以及使用转化研究框架。然而,有效的员工和患者教育计划，以及全面的多学科护理，在开发更大的研究基础之前，应将其视为标准护理。
方法：使用MEDLINE进行搜索，EMBASE,和CINAHL数据库。使用Cochrane协作偏差风险工具和建议评估分级评估来评估研究质量，发展,和评估（等级）评估。
结果：11项研究符合纳入标准。汇总数据发现有针对性的HETF对患者进行教育，看护者,员工在接受教育后立即显著提高了知识水平，并在3-6个月内持续。多式联运干预，包括组建专业的HETF团队，显着减少并发症，如感染，胃造口术阻塞,管位移,和饲料不耐受，但不能显著减少计划外的医院接触(门诊就诊，住院治疗,和紧急演示)。由于纳入研究的偏倚风险较高，有低质量的证据来支持员工培训，患者教育,和专门的HETF团队。
结论：这篇综述强调了需要进一步的高质量研究，以允许更高水平的证据来确定旨在改善接受HETF患者预后的干预措施的有效性。未来的研究需要包括对生活质量的更多评估，从经济角度量化干预措施的价值，以及使用转化研究框架。然而,有效的员工和患者教育计划，以及全面的多学科护理，在开发更大的研究基础之前，应将其视为标准护理。
