哮喘联盟

   摘要
   背景：哮喘是最常见的儿童疾病之一。按指南进行的临床护理对病人的治疗结果有积极的影响。现有一些哮喘治疗指南以及提醒方法以利于将它们贯穿于临床工作流程中。我们的目的是确定一种能让指南实施最普遍的方法，找出能最大程度改善临床护理的方法，并研究与指南成功且持续实施最相关的因素。
   方法：在PUBMED(MEDLINE)、OVID CINAHL、ISI Web of Science以及EMBASE上搜索相关研究。纳入标准：评估哮喘指南的研究、评估指南中干预措施的临床试验以及干预措施的定性研究等。排除标准：研究主体为非人类，对药物疗效的研究中没有评估体系或仅涉及教育干预，病例报道、调查、社论或写给编辑的信等。
   结果：我们从14478例摘要中选取了101篇有全文的文章进行分析。最普遍的研究方法为前后处理，其次是前瞻性研究、基于人口的病例分析或连续病例分析，以及随机临床试验。书面提醒模式最为常用的是计算机管理，其次是计算机生成的及其它形式。没有研究报道其干预措施降低了健康护理人员的执行效率或恶化了患者治疗效果。最常用主要结局指标为患者对提供的或规定的指南的依从性以及主要的临床指标（包括患者的治疗效果、生活质量以及住院时间等）。
   结论：书面提醒的实施方法仍然是目前指南实施最常用的手段，但是哮喘指南提醒系统可用版本在逐渐增加。关于计算机化的以及计算机生成的研究也在逐渐增多。不管实施方法是什么，哮喘指南均改善了患者的护理并提高了健康护理人员的执行效率。
 

（杨冬 审校）
BMC Med Inform Decis Mak. 2014 Sep 9;14(1):82. [Epub ahead of print]

 

A systematic review of the implementation and impact of asthma protocols.
 

Dexheimer JW, Borycki EM, Chiu KW, Johnson KB, Aronsky D.
 

ABSTRACT
BACKGROUND: Asthma is one of the most common childhood illnesses. Guideline-driven clinical care positively affects patient outcomes for care. There are several asthma guidelines and reminder methods for implementation to help integrate them into clinical workflow. Our goal is to determine the most prevalent method of guideline implementation; establish which methods significantly improved clinical care; and identify the factors most commonly associated with a successful and sustainable implementation.
METHODS: PUBMED (MEDLINE), OVID CINAHL, ISI Web of Science, and EMBASE.Study Selection: Studies were included if they evaluated an asthma protocol or prompt, evaluated an intervention, a clinical trial of a protocol implementation, and qualitative studies as part of a protocol intervention. Studies were excluded if they had non-human subjects, were studies on efficacy and effectiveness of drugs, did not include an evaluation component, studied an educational intervention only, or were a case report, survey, editorial, letter to the editor.
RESULTS: From 14,478 abstracts, we included 101 full-text articles in the analysis. The most frequent study design was pre-post, followed by prospective, population based case series or consecutive case series, and randomized trials. Paper-based reminders were the most frequent with fully computerized, then computer generated, and other modalities. No study reported a decrease in health care practitioner performance or declining patient outcomes. The most common primary outcome measure was compliance with provided or prescribing guidelines, key clinical indicators such as patient outcomes or quality of life, and length of stay.
CONCLUSIONS: Paper-based implementations are by far the most popular approach to implement a guideline or protocol. The number of publications on asthma protocol reminder systems is increasing. The number of computerized and computer-generated studies is also increasing. Asthma guidelines generally improved patient care and practitioner performance regardless of the implementation method.
 

BMC Med Inform Decis Mak. 2014 Sep 9;14(1):82. [Epub ahead of print]