...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Journal of medical Internet research >Electronic Symptom Reporting Between Patient and Provider for Improved Health Care Service Quality: A Systematic Review of Randomized Controlled Trials. Part 2: Methodological Quality and Effects
【24h】

Electronic Symptom Reporting Between Patient and Provider for Improved Health Care Service Quality: A Systematic Review of Randomized Controlled Trials. Part 2: Methodological Quality and Effects

机译：患者和提供者之间的电子症状报告，以改善医疗服务质量：随机对照试验的系统评价。第2部分：方法论的质量和影响

获取原文
   

获取外文期刊封面封底 >>

       
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Background: We conducted in two parts a systematic review of randomized controlled trials (RCTs) on electronic symptom reporting between patients and providers to improve health care service quality. Part 1 reviewed the typology of patient groups, health service innovations, and research targets. Four innovation categories were identified: consultation support, monitoring with clinician support, self-management with clinician support, and therapy.Objective: To assess the methodological quality of the RCTs, and summarize effects and benefits from the methodologically best studies.Methods: We searched Medline, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and IEEE Xplore for original studies presented in English-language articles between 1990 and November 2011. Risk of bias and feasibility were judged according to the Cochrane recommendation, and theoretical evidence and preclinical testing were evaluated according to the Framework for Design and Evaluation of Complex Interventions to Improve Health. Three authors assessed the risk of bias and two authors extracted the effect data independently. Disagreement regarding bias assessment, extraction, and interpretation of results were resolved by consensus discussions.Results: Of 642 records identified, we included 32 articles representing 29 studies. No articles fulfilled all quality requirements. All interventions were feasible to implement in a real-life setting, and theoretical evidence was provided for almost all studies. However, preclinical testing was reported in only a third of the articles. We judged three-quarters of the articles to have low risk for random sequence allocation and approximately half of the articles to have low risk for the following biases: allocation concealment, incomplete outcome data, and selective reporting. Slightly more than one fifth of the articles were judged as low risk for blinding of outcome assessment. Only 1 article had low risk of bias for blinding of participants and personnel. We excluded 12 articles showing high risk or unclear risk for both selective reporting and blinding of outcome assessment from the effect assessment. The authors’ hypothesis was confirmed for 13 (65%) of the 20 remaining articles. Articles on self-management support were of higher quality, allowing us to assess effects in a larger proportion of studies. All except one self-management interventions were equally effective to or better than the control option. The self-management articles document substantial benefits for patients, and partly also for health professionals and the health care system.Conclusion: Electronic symptom reporting between patients and providers is an exciting area of development for health services. However, the research generally is of low quality. The field would benefit from increased focus on methods for conducting and reporting RCTs. It appears particularly important to improve blinding of outcome assessment and to precisely define primary outcomes to avoid selective reporting. Supporting self-management seems to be especially promising, but consultation support also shows encouraging results.
机译：背景：我们分两部分对患者和提供者之间电子症状报告的随机对照试验（RCT）进行了系统评价，以提高医疗服务质量。第1部分回顾了患者群体的类型，卫生服务创新和研究目标。确定了四个创新类别：咨询支持，在临床医生支持下进行监测，在临床医生支持下进行自我管理以及治疗。目的：评估RCT的方法学质量，并总结方法学上最佳研究的效果和好处。方法：我们进行了搜索Medline，EMBASE，PsycINFO，Cochrane对照试验中央注册和IEEE Xplore用于1990年至2011年11月之间英语文章发表的原始研究。根据Cochrane的建议以及理论证据和临床前测试来判断偏倚和可行性的风险。根据改善健康的复杂干预措施设计和评估框架进行评估。三位作者评估了偏见的风险，两位作者独立提取了效果数据。结果：在确定的642笔记录中，我们包括32篇代表29项研究的文章，解决了有关偏倚评估，提取和结果解释的分歧。没有文章满足所有质量要求。所有干预措施都可以在现实环境中实施，几乎所有研究都提供了理论依据。但是，只有三分之一的文章报道了临床前测试。我们判断四分之三的文章对随机序列分配的风险低，而大约一半的文章对以下偏差具有低风险：分配隐藏，不完整的结果数据和选择性报告。略多于五分之一的文章被认为对结局评估盲目低风险。只有一篇文章对参与者和人员致盲的偏见风险低。我们从效果评估中排除了12篇文章，这些文章对选择性报告和结果评估盲目显示高风险或不清楚风险。其余20篇文章中有13篇（65％）证实了作者的假设。有关自我管理支持的文章质量较高，这使我们能够在更大比例的研究中评估效果。除一项自我管理干预措施外，所有措施均有效地优于或优于对照方案。自我管理文章记录了对患者的巨大好处，部分还对卫生专业人员和卫生保健系统有益。结论：患者和提供者之间的电子症状报告是卫生服务发展的令人兴奋的领域。但是，研究通常质量较低。该领域将从对执行和报告RCT方法的更多关注中受益。似乎尤其重要的是，要改善结果评估的盲目性并精确定义主要结果，以避免选择报告。支持自我管理似乎特别有希望，但是咨询支持也显示出令人鼓舞的结果。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号