慢性病管理(CDM)通过持续的知识翻译(KT)干预措施确保长期,高质量的护理。我们评估了支持CDM的KT干预措施的实施及其在老年人中持续的有效性。
设计:使用集成KT与17位知识用户进行荟萃分析的系统回顾。
随机对照试验(RCT)包括患有慢性疾病的成年人(>65岁),他们的照顾者,卫生和/或政策决策者接受KT干预以进行CDM干预至少12个月(与其他KT干预或常规护理相比)。
我们搜索了MEDLINE,EMBASE,以及从每个数据库开始到2020年3月的Cochrane中央对照试验登记册。
可持续性,保真度,遵守KT对CDM实践的干预措施,生活质量(QOL)和护理质量(QOC)。数据提取,偏倚风险(ROB)评估:我们筛选,摘要和评估的文章(有效的实践和组织的护理ROB工具)独立和一式两份。
我们进行了随机效应和固定效应荟萃分析,并对二分数据的连续和比值比(OR)进行了估计平均差(MD)。
我们纳入了158个随机对照试验(973,074名参与者[961,745名患者,5540名护理人员,5789个提供者])和39个伴随报告,包括329KT干预措施,涉及患者(43.2%),医疗保健提供者(20.7%)或两者(10.9%)。我们确定了16项研究,描述为评估8.1%干预措施的可持续性,67项研究在35.6%的干预措施中评估依从性,20项研究在8.7%的干预措施中评估保真度。大多数荟萃分析表明,KT干预措施改善了生活质量,但不精确(36项简短形式心理[SF-36心理]:MD1.11,95%置信区间[CI][-1.25,3.47],14项随机对照试验,5876名与会者,I2=96%;欧洲QOL-5维度:MD0.01,95%CI[-0.01,0.02],15项随机对照试验,6628名与会者,I2=25%;圣乔治呼吸问卷:MD-2.12,95%CI[-3.72,-0.51]4412项随机对照试验,2893名与会者,I2=44%)。KT干预改善了QOC(OR1.55,95%CI[1.29,1.85],12RCTS,5271名参与者,I2=21%)。
KT干预的可持续性很少被定义和评估。持续的KT干预有可能改善CDM老年人的QOL和QOC。然而,它们的整体功效仍然不确定,并且因效果调节剂而异,包括干预类型,慢性病编号,合并症,参与者年龄。
PROSPEROCRD42018084810。
Chronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and their efficacy when sustained in older adults.
Design: Systematic
review with meta-analysis engaging 17 knowledge users using integrated KT.
Randomized controlled trials (RCTs) including adults (> 65 years old) with chronic disease(s), their caregivers, health and/or policy-decision makers receiving a KT intervention to carry out a CDM intervention for at least 12 months (versus other KT interventions or usual care).
We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database\'s inception to March 2020.
Sustainability, fidelity, adherence of KT interventions for CDM practice, quality of life (QOL) and quality of care (QOC). Data extraction, risk of bias (ROB) assessment: We screened, abstracted and appraised articles (Effective Practice and Organisation of Care ROB tool) independently and in duplicate.
We performed both random-effects and fixed-effect meta-analyses and estimated mean differences (MDs) for continuous and odds ratios (ORs) for dichotomous data.
We included 158 RCTs (973,074 participants [961,745 patients, 5540 caregivers, 5789 providers]) and 39 companion reports comprising 329 KT interventions, involving patients (43.2%), healthcare providers (20.7%) or both (10.9%). We identified 16 studies described as assessing sustainability in 8.1% interventions, 67 studies as assessing adherence in 35.6% interventions and 20 studies as assessing fidelity in 8.7% of the interventions. Most meta-analyses suggested that KT interventions improved QOL, but imprecisely (36 item Short-Form mental [SF-36 mental]: MD 1.11, 95% confidence interval [CI] [- 1.25, 3.47], 14 RCTs, 5876 participants, I2 = 96%; European QOL-5 dimensions: MD 0.01, 95% CI [- 0.01, 0.02], 15 RCTs, 6628 participants, I2 = 25%; St George\'s Respiratory Questionnaire: MD - 2.12, 95% CI [- 3.72, - 0.51] 44 12 RCTs, 2893 participants, I2 = 44%). KT interventions improved QOC (OR 1.55, 95% CI [1.29, 1.85], 12 RCTS, 5271 participants, I2 = 21%).
KT intervention sustainability was infrequently defined and assessed. Sustained KT interventions have the potential to improve QOL and QOC in older adults with CDM. However, their overall efficacy remains uncertain and it varies by effect modifiers, including intervention type, chronic disease number, comorbidities, and participant age.
PROSPERO CRD42018084810.