Realist review

现实主义评论
  • 文章类型: Review
    通过促进以患者为中心的协调护理,医疗服务的大规模和小规模转型以改善患者体验,继续处于美国卫生系统努力的最前沿。作为质量改进(QI)项目的一部分,中西部卫生系统,我们探索了一系列表现良好的组织,目的是确定以患者为中心的护理和/或护理协调(PCC/CC)的最佳实践.最佳做法的确定是通过对支持每个病例的三项PCC/CC干预措施的同行评审文献进行快速现实性审查来完成的。评估了负责成功干预结果的机制和相关的机构级别的促进者,跨案例分析为卫生系统领导提供了高层次的重点项目,包括(1)围绕PCC/CC的机构价值,(2)优化IT基础设施,增强性能和沟通,(3)加强问责制的薪酬结构和就业模式,(四)支持实施工作的组织机构。卫生系统可能会使用此审查来深入了解机构层面的因素如何促进小规模的PCC/CC行为,或在自己的QI项目中进行类似的评估。根据我们的分析,我们建议寻求在任何级别或规模上改善PCC/CC的卫生系统,以评估IT基础设施如何影响提供者-提供者和提供者-患者之间的沟通,以及PCC/CC的机构优先次序在绩效反馈中的体现和问责程度,激励,以及部门和设置之间共享的价值观。理想情况下,这项评估工作应由专门致力于PCC/CC实施工作的跨部门组织机构执行和/或支持。
    Large- and small-scale transformation of healthcare delivery toward improved patient experience through promotion of patient-centered and coordinated care continues to be at the forefront of health system efforts in the United States. As part of a Quality Improvement (QI) project at a large, midwestern health system, a case series of high-performing organizations was explored with the goal of identifying best practices in patient-centered care and/or care coordination (PCC/CC). Identification of best practices was done through rapid realist review of peer-reviewed literature supporting three PCC/CC interventions per case. Mechanisms responsible for successful intervention outcomes and associated institutional-level facilitators were evaluated, and cross-case analysis produced high-level focus items for health system leadership, including (1) institutional values surrounding PCC/CC, (2) optimization of IT infrastructure to enhance performance and communication, (3) pay structures and employment models that enhance accountability, and (4) organizing bodies to support implementation efforts. Health systems may use this review to gain insight into how institutional-level factors may facilitate small-scale PCC/CC behaviors, or to conduct similar assessments in their own QI projects. Based on our analysis, we recommend health systems seeking to improve PCC/CC at any level or scale to evaluate how IT infrastructure affects provider-provider and provider-patient communication, and the extent to which institutional prioritization of PCC/CC is manifest and held accountable in performance feedback, incentivization, and values shared among departments and settings. Ideally, this evaluation work should be performed and/or supported by cross-department organizing bodies specifically devoted to PCC/CC implementation work.
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  • 文章类型: Journal Article
    这篇现实主义评论的目的是,根据最近研究的证据,了解护士主导的病例管理干预措施如何在慢性病管理中实施,以及在什么情况下这些干预是成功的。审查遵循了现实主义的审查方法。从四个电子数据库中,纳入了2011年1月至2020年2月期间发表的20项经验性和主要由护士主导的病例管理干预研究.对于每一项研究,因果关系被探索,和发现被整合。三种情况,五种机制,发现了三个主要结果,并确定了几个上下文机制结果字符串。进一步的分析和综合研究表明,当干预持续时间时,服务交付模式,服务类型是合适的,以及为考虑护理的患者提供的服务数量,病例管理干预改变了慢性病患者的预后。最后,我们基于综述结果开发了一个解释性概念框架,以指导护士管理者和研究人员.
    This realist review aims, with evidence from recent studies, to understand both how nurse-led case management interventions are implemented in the management of chronic illnesses, and in what circumstances these interventions are successful. The review followed the realist review methodology. From four electronic databases, twenty empirical and primary nurse-led case management intervention studies published between January 2011 and February 2020 were included. For each study, causality was explored, and findings were integrated. Three contexts, five mechanisms, and three major outcomes were found, and several context-mechanism-outcome strings were identified. Further analysis and synthesis of the studies showed that when duration of intervention, service delivery mode, and types of services are appropriate, as well as number of services with patients considering care is provided, case managment interventions change outcomes for patients with chronic illnesses. Finally, an explanatory conceptual framework based on the review results was developed to guide nurse managers and researchers.
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  • 文章类型: Journal Article
    目的:将证据转化为实践是公共卫生的优先事项。全球,损伤是发病率和死亡率的主要原因。案例研究出版物很常见,并提供了从患者到系统级别的医疗保健成功干预措施的潜在可重复示例。然而,关于如何利用案例研究出版物的数据是有限的。据我们所知,世界卫生组织(世卫组织)在政策层面发表了关于伤害护理的唯一国际案例研究。我们旨在确定这些伤害护理案例研究已转化为实践的程度,并确定总体上增强伤害护理案例研究的证据到实践途径的机会。
    方法:我们通过搜索标题对19个数据库进行了系统综述,“加强对伤者的护理:从世界各地吸取的成功故事和教训。“数据综合包括现实主义的叙述方法和两名作者独立审查伤害主题的文章,参考详细信息,和利用程度。
    结果:47种出版物引用了案例研究的汇编,其中20例包括对一个或多个具体案件的进一步描述,并进行了叙述性审查。最常见的类别是医院护理(15种出版物),泰国的质量改进(QI)计划(10种出版物)是最常见的案例。还经常被引用的是院前护理的案例研究(10种出版物)。很少使用有关康复(3种出版物)和创伤系统(2种出版物)的案例研究。没有参考文献描述了转换为新场景的案例。
    结论:唯一可用的政策级伤害护理案例研究集合已被适度利用,但我们没有发现案例研究转化为新情况的证据。QI计划似乎特别适合通过案例研究进行知识共享。院前护理也显示出希望。有必要更加重视与创伤系统有关的康复和卫生政策。在总体上评估案例研究集合的使用时,还需要更加严格的方法。
    OBJECTIVE: Translation of evidence to practice is a public health priority. Worldwide, injury is a leading cause of morbidity and mortality. Case study publications are common and provide potentially reproducible examples of successful interventions in healthcare from the patient to systems level. However, data on how well case study publications are utilized are limited. To our knowledge, the World Health Organization (WHO) published the only collection of international case studies on injury care at the policy level. We aimed to determine the degree to which these injury care case studies have been translated to practice and to identify opportunities for enhancement of the evidence-to-practice pathway for injury care case studies overall.
    METHODS: We conducted a systematic review across 19 databases by searching for the title, \"Strengthening care for the injured: Success stories and lessons learned from around the world.\" Data synthesis included realist narrative methods and two authors independently reviewed articles for injury topics, reference details, and extent of utilization.
    RESULTS: Forty-seven publications referenced the compilation of case studies, 20 of which included further descriptions of one or more of the specific cases and underwent narrative review. The most common category utilized was hospital-based care (15 publications), with the example of Thailand\'s quality improvement (QI) programme (10 publications) being the most commonly cited case. Also frequently cited were case studies on prehospital care (10 publications). There was infrequent utilization of case studies on rehabilitation (3 publications) and trauma systems (2 publications). No reference described a case translated to a new scenario.
    CONCLUSIONS: The only available collection of policy-level injury care case studies has been utilized to a moderate extent however we found no evidence of case study translation to a new circumstance. QI programs seem especially amenable for knowledge-sharing through case studies. Prehospital care also showed promise. Greater emphasis on rehabilitation and health policy related to trauma systems is warranted. There is also a need for greater methodologic rigor in evaluation of the use of case study collections in general.
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