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首页> 外文期刊>BMC Health Services Research >Organising health care services for people with an acquired brain injury: an overview of systematic reviews and randomised controlled trials
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Organising health care services for people with an acquired brain injury: an overview of systematic reviews and randomised controlled trials

机译：为后天性脑损伤的人组织医疗服务：系统评价和随机对照试验的概述

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Background Acquired brain injury (ABI) is the leading cause of disability worldwide yet there is little information regarding the most effective way to organise ABI health care services. The aim of this review was to identify the most up-to-date high quality evidence to answer specific questions regarding the organisation of health care services for people with an ABI. Methods We conducted a systematic review of English papers using MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library. We included the most recently published high quality systematic reviews and any randomised controlled trials, non-randomised controlled trials, controlled before after studies or interrupted time series studies published subsequent to the systematic review. We searched for papers that evaluated pre-defined organisational interventions for adults with an ABI. Organisational interventions of interest included fee-for-service care, integrated care, integrated care pathways, continuity of care, consumer engagement in governance and quality monitoring interventions. Data extraction and appraisal of included reviews and studies was completed independently by two reviewers. Results A total of five systematic reviews and 21 studies were included in the review; eight of the papers (31%) included people with a traumatic brain injury (TBI) or ABI and the remaining papers (69%) included only participants with a diagnosis of stroke. We found evidence supporting the use of integrated care to improve functional outcome and reduce length of stay and evidence supporting early supported discharge teams for reducing morbidity and mortality and reducing length of stay for stroke survivors. There was little evidence to support case management or the use of integrated care pathways for people with ABI. We found evidence that a quality monitoring intervention can lead to improvements in process outcomes in acute and rehabilitation settings. We were unable to find any studies meeting our inclusion criteria regarding fee-for-service care or engaging consumers in the governance of the health care organisation. Conclusions The review found evidence to support integrated care, early supported discharge and quality monitoring interventions however, this evidence was based on studies conducted with people following stroke and may not be appropriate for all people with an ABI.
机译：背景技术后天性脑损伤（ABI）是世界范围内致残的主要原因，但关于组织ABI保健服务的最有效方法的信息很少。这次审查的目的是找出最新的高质量证据，以回答有关为ABI患者提供医疗保健服务的具体问题。方法我们使用MEDLINE，EMBASE，PsycINFO，CINAHL和Cochrane图书馆对英语论文进行了系统的综述。我们纳入了最近发表的高质量的系统评价，以及所有随机对照试验，非随机对照试验，在研究后进行对照或在系统评价后发布的中断时间序列研究。我们搜索了评估针对ABI成人的预定义组织干预措施的论文。感兴趣的组织干预措施包括按服务收费护理，综合护理，综合护理途径，护理的连续性，消费者参与治理和质量监控措施。两名评论者独立完成了对纳入的评论和研究的数据提取和评估。结果共有5篇系统评价和21篇研究被纳入评价。其中八篇论文（31％）包括颅脑外伤（ABI）患者，其余论文（69％）仅包括诊断为中风的参与者。我们发现支持综合护理以改善功能结局和减少住院时间的证据，并支持早期支持出院团队减少卒中幸存者的发病率和死亡率并缩短住院时间的证据。几乎没有证据支持ABI患者进行病例管理或使用综合护理途径。我们发现有证据表明，质量监控干预措施可以改善急性和康复环境下的过程结果。我们找不到任何符合我们纳入标准的有关按服务收费护理或使消费者参与医疗保健组织治理的研究。结论该综述发现了支持综合护理，早期支持出院和质量监测干预措施的证据，但是，该证据是基于对卒中后患者的研究，可能并不适合所有ABI患者。

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