提高急救医疗服务纵向衔接的干预及效果:基于随机对照研究的系统综述  

Effectiveness of interventions to improve sequential coordination of care in emergency medical services:a systematic review of randomized controlled studies

作　　者：麦丽克扎提·麦麦提明 袁蓓蓓 李佳 黄可沛 金音子[1,3] MAIMAITIMING Mailikezhati;YUAN Bei-bei;LI Jia;HUANG Ke-pei;JIN Yin-zi(Department of Global Health,School of Public Health,Peking University,Beijing 100080,China;不详)

机构地区：[1]北京大学公共卫生学院全球卫生学系,北京100191 [2]北京大学中国卫生发展研究中心,北京100191 [3]北京大学全球健康发展研究院,北京100191

出　　处：《现代预防医学》2024年第14期2593-2597,2604,共6页Modern Preventive Medicine

基　　金：国家自然科学基金项目(72274005);北京自然科学基金项目(9232009)。

摘　　要：目的系统总结提高急救医疗服务协调性的随机对照干预研究,以不同场景下实现急救医疗服务无缝衔接的纵向干预为主要关注点,为急救医疗体系衔接优化提供首份循证依据。方法采用关键词和主题检索的方式,计算机检索Embase、PubMed、中国知网(CNKI)、万方数据库等八个中英文数据库中的相关文献,对纳入文献进行筛选和质量评价,以救治时间、患者结局、满意度作为评价指标,分别分析干预措施的效果。结果最终纳入文献19篇。纵向干预最多可缩短院前时间68.7分钟,院内时间79.8分钟,不良事件发生率可降低3.8%~16.7%。患者的再入院率、死亡率和并发症发生率最大分别可降低20%、17%、28.9%。干预组的患者生活能力和满意度均高于对照组。结论急救医疗服务协调性干预在缩短救治时间、改善患者结局方面均有积极作用。鉴于现有证据的研究质量,研究地点局限于少数国家,且部分研究样本量较少,未来研究应注重研究设计的严谨性和结果报告的完整性,增加相关干预措施的有效性和可行性。Objective To systematically analyze randomized controlled trials(RCT)on improving the coordination of care in emergency medical services(EMS),and to mainly focus on sequential intervention that aimed to achieve seamless care between difference service settings,as well as to provide evidence-based suggestion for improving the integration of emergency medical system.Methods Using keyword and Mesh-term search,Embase,PubMed,CNKI,Wanfang Database and other eight databases were searched to identify related studies,and then the interventions were confirmed by study screening and quality evaluation.Effectiveness of the interventions were assessed according to treatment time,patient outcomes and satisfaction.Results In total,19 articles were included.Sequential intervention maximumly could shorten pre-hospital time and in-hospital time by 68.7 minutes and 79.8 minutes,respectively.The incidence of adverse events could be reduced by from 3.8%to 16.7%.There were significant reductions in the rates of readmission(20%),mortality(17%)and complication(28.9%).The functional status and satisfaction of the patients in the intervention group were better than that in the control group.Conclusion Interventions aiming to improve coordination of care in EMS play a positive role in shortening treatment time and improving patient outcome.Given the quality of the included studies,study locations and study sample,future studies should pay more attention to the rigorousness of their study design and the completeness of their outcome report.

关 键 词：急救医疗体系 服务协调性 随机对照研究 系统综述 

分 类 号：R197.1[医药卫生—卫生事业管理]