以患者为中心的慢阻肺患者参与医疗质量改进的实施现状:一项范围综述
urrent status of implementation of patient involvement in health care to improve quality of care among chronic obstructive pulmonary disease:a scoping review
背景??以患者为中心的医疗质量改进中,将患者从医疗服务的接受者转变为合作者,将患者在医疗全流程中的体验和需求整合到医疗服务实践中,以提高医疗服务的有效性、效率和质量。然而,已被证明有效的以患者为中心的患者参与医疗质量改进策略在我国慢阻肺领域中如何实施尚有待探索。目的??对国内外慢阻肺患者参与医疗质量改进策略的实施现状进行范围综述,旨在为构建适合我国环境的慢阻肺患者参与实施策略提供参考。方法 ?采用澳大利亚乔安娜布里格斯研究所的范围综述指南为方法学框架,计算机检索 PubMed、Embase、Cochrane Library、中国知网、万方数据知识服务平台和中华医学期刊全文数据库,检索时限为建库至 2022-11-29。采用主题分析法梳理慢阻肺患者参与的实施现状。结果 ?共纳入37篇文献。根据参与类别分为直接参与诊疗、参与组织层面的设计与管理、及参与临床研究三类。根据参与强度分为咨询、参与和合作领导三层。参与强度与类别交叉为 9 类参与行为矩阵。慢阻肺患者参与实施主要体现在5类8项行为:包括直接参与诊疗类的参与(患者对治疗计划提出意愿和偏好);组织管理层面的咨询(调查了解患者治疗体验、组织患者讨论其关注的问题)和参与(参与医疗质量改进工具开发);以及患者接受临床研究层面的咨询(倾听患者需求)和参与(对干预措施提出意愿和偏好、参与评估工具开发、参与研究设计与实施讨论)。调查患者治疗体验(10/37,27.03%)及收集患者对研究干预措施的意愿和偏好(10/37,27.03%)是实施较多的两类慢阻肺患者参与行为。结论??患者参与医疗质量改进的行为措施较多,但在慢阻肺领域落地实践的尚较少,且极少见患者参与对临床结局及生活质量的改善评估,如何促进我国乃至全球慢阻肺患者参与医疗质量改进的实施仍有待进一步探索。
Background??In patient involvementpatients are transforming from mere recipients to collaborators in medical services by integrating their experiences and needs throughout the entire healthcare process into medical practice. This aims to enhance the effectivenessefficiencyand quality of healthcare services. Howeverthe implementation of proven patientcentered strategies for patient involvement in the quality improvement among chronic obstructive pulmonary diseaseCOPDin our country remains to be explored.Objective??This scoping review systematically reviews and analyzes the existing strategies for patient involvement among patients with COPD to provide a reference for implementation that in China.Methods ?Employing the scoping review guidelines of Joanna Briggs Institute in Australia as the methodological frameworkthe relevant studies on patient involvement among patient with COPD were searched by computer on PubMedEmbaseCochrane LibraryCNKIWanfang DatabaseChina Biology Medicine disc. A thematic analysis was methodically applied to distill and synthesize findings. Results ?A total of 37 articles were included in this review. The categorization of patient involvement was divided into three typesdirect involvement in medical careorganizational-leveland clinical research. Based on the intensity of involvementcategories were further classified into three levelsconsultationengagementand collaborative leadership. A nine-category matrix of patient involvement behaviors was constructed through intensity and type. The implementation of COPD patient engagement was primarily reflected in five categories encompassing eight behaviorsincludingintegration in direct medical carepatients expressing their preferences and wishes regarding treatment plansconsultation at the organizational management levelassessing patient treatment experiences and organizing discussions around patients'?concernsas well as involvement in clinical researchincluding consultationlistening to patient needsand engagementexpressing preferences and wishes for interventionsinvolved in the development of assessment toolsand in discussions about research design and implementation. Assessing patient treatment experiences10 articles27.03%and expressing patient preferences and wishes regarding interventions10 articles27.03%were the two most frequently implemented behaviors of patient involvement in COPD. Conclusion??There are numerous measures for patient involvement in the improvement of medical qualitybut there is still limited practice in the field of COPD. Very few studies have assessed the impact of patient involvement on clinical outcomes and quality of lifeindicating that the practice of patient involvement in China requires further exploration.
李信麟、李姝润、陈亚红、褚红玲
10.12114/j.issn.1007-9572.2024.0082
医药卫生理论医学研究方法内科学
慢性阻塞性肺病患者参与医疗质量实施范围综述
李信麟,李姝润,陈亚红,褚红玲.以患者为中心的慢阻肺患者参与医疗质量改进的实施现状:一项范围综述[EB/OL].(2024-05-27)[2025-08-18].https://chinaxiv.org/abs/202405.00301.点此复制
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