通过将干预与结果对齐,最大限度地提高手术成功:系统性审查
Bonnie A Armstrong1,2, Arthur Tung2, Lisha Lo3
1From the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
概括
基于系统的干预措施,虽然不太常见,但与教育等基于人的方法相比,显著改善了外科结果. 这项研究指导了更好的患者安全干预策略.
科学领域:
- 手术安全和改善手术质量
- 医疗保健系统研究 医疗保健系统研究
背景情况:
- 尽管做了大量的努力,外科手术的不良事件仍然存在.
- 目前专注于以个人为基础的干预措施的效果可能不如以系统为基础的方法.
- 对于改善手术结果的最有影响力的干预措施的了解有限.
研究的目的:
- 确定外科手术中常见的手术内干预措施.
- 评估这些干预措施在改善手术结果方面的有效性.
主要方法:
- 在多个数据库 (Medline,CINAHL,Embase,PsycINFO,Scopus,Cochrane) 进行了全面的两步文献搜索.
- 确定了系统性和元分析性审查,并选择了个别研究.
- 使用定性内容分析来分类干预和结果,并提取干预细节和发现.
主要成果:
- 分析包括575项研究,超过520万例病例,以及来自50个国家的数据.
- 基于人的干预措施 (教育,政策) 是最常见的,但主要改善了人际关系结果.
- 基于系统的干预 (技术,认知辅助工具,标准化) 较少发生,但在所有结果类型中都有效.
结论:
- 基于系统的干预措施显示,与广泛实施的基于人的干预措施相比,对整体外科结果的影响更大.
- 研究结果为调整干预措施与预期的外科结果提供了关键的见解.
- 优化干预策略是提高患者安全和手术性能的关键.
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