改善低收入和中等收入国家重症监护的干预措施:系统审查
Duncan Wagstaff1, Sumaiya Arfin2, Alba Korver3
1University College London, London, UK.
Intensive care medicine
|May 15, 2024
概括
低收入和中等收入国家 (LMICs) 成人重症监护的质量改进 (QI) 显示了稀疏的高风险证据. 多方面的干预,利益相关者的参与,以及适应当地工作流程是有效实施的关键.
科学领域:
- 关键护理医学 关键护理医学
- 医疗服务研究 医疗服务研究
- 实施科学 实施科学
背景情况:
- 质量改进 (QI) 对于提高重症监护中的患者结果至关重要.
- 在低收入和中等收入国家 (LMICs) 实施QI干预面临着独特的挑战.
- 了解QI在LMIC重症监护机构的有效性和障碍至关重要.
研究的目的:
- 系统地审查LMIC中成人重症监护中的QI干预措施的类型,影响,证据质量,障碍和促进者.
- 确定有效的QI策略和影响其成功实施的因素.
- 为了突出当前证据库中的空白.
主要方法:
- 在主要数据库 (MEDLINE,EMBASE,Cochrane Library,ClinicalTrials.gov) 进行了全面的搜索.
- 包括2000年以后发表的研究,重点关注LMIC中成人重症监护QI.
- 使用ROB 2.0/ROBINS-I评估偏差风险;使用知识翻译框架对干预策略进行分类;通过投票计数综合有效性;使用实施研究综合框架对障碍和促进因素进行叙述综合.
主要成果:
- 包括78项研究,其偏差风险一般很高.
- 常见的QI策略包括教育,审计和反 (A&F),以及协议/指南/捆绑/检查清单 (PGBC).
- 结合教育和A&F,或PGBC与教育和A&F的多方面的干预措施,显著改善了过程和结果措施 (p<0.05). 促进者包括利益相关者参与和组织准备;障碍包括缺乏资源和工作流不兼容.
结论:
- 对于LMIC重症监护中的QI的证据有限,并带有高偏差风险,但表明多方面的干预措施是最有效的.
- 成功实施取决于与利益相关者共同设计干预措施,沟通优势,利用当地冠军,并适应反.
- 未来的研究应该采用混合研究设计,过程评估,并遵守报告准则,以加强LMIC重症监护中QI的证据基础.
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