Swapnil Ghotane, Raeena Hirve, Julia Forman, Daniel Tan, Zak Achercouk, Ingrid Wolfe
{"title":"为有特殊健康和护理需求的儿童和青少年提供综合护理：系统性综述。","authors":"Swapnil Ghotane, Raeena Hirve, Julia Forman, Daniel Tan, Zak Achercouk, Ingrid Wolfe","doi":"10.1136/archdischild-2024-326905","DOIUrl":null,"url":null,"abstract":"<p><strong>Context: </strong>There is a dearth of high-quality evidence on integrated, coordinated and cost-effective care for children with special health and care needs (CSHCN).</p><p><strong>Objective: </strong>To assess the effectiveness of integrated/coordinated care models for CSHCN.</p><p><strong>Data sources: </strong>Embase, Ovid Medline(R), HMIC Health Management Information Consortium, Maternity & Infant Care Database (MIDIRS), PsycARTICLES, PsycINFO, Social Policy and Practice, Cochrane Central Register of Controlled Trials (CENTRAL), Global Health and PubMed.</p><p><strong>Study selection: </strong>Inclusion criteria comprised (1) randomised trials, including cluster randomised trials; (2) an integrated/coordinated care intervention; (3) for children and young people under 25 with special healthcare needs including medical complexity; (4) assessing child-centred outcomes, health-related quality of life among parents and carers, and health or social care use, processes of care and satisfaction with care.</p><p><strong>Data extraction: </strong>Data were extracted and assessed by two researchers, and descriptive data were synthesised according to outcome and intervention.</p><p><strong>Results: </strong>14 randomised controlled studies were included. Seven out of the 14 studies had a dedicated key worker/care coordinator as a vital part of the integrated/coordinated care intervention; however, the certainty of evidence for all outcomes was either 'low' or 'very low'.</p><p><strong>Limitations: </strong>Included studies were mostly from high-income countries. Variable study outcomes and quality of evidence precluded meta-analysis.</p><p><strong>Conclusions: </strong>Limited evidence favours integrated care for CSHCN using a dedicated key worker/care coordinator; however, heterogeneity in study outcomes and definitions of CSHCN limit the strength and utility of evidence obtained. Recommendations are made for improving integrated care practice, research and evaluation which are important for evidence-based health services for CSHCN.</p><p><strong>Prospero registration number: </strong>CRD42020209320.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"924-931"},"PeriodicalIF":4.3000,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503122/pdf/","citationCount":"0","resultStr":"{\"title\":\"Integrated care for children and young people with special health and care needs: a systematic review.\",\"authors\":\"Swapnil Ghotane, Raeena Hirve, Julia Forman, Daniel Tan, Zak Achercouk, Ingrid Wolfe\",\"doi\":\"10.1136/archdischild-2024-326905\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Context: </strong>There is a dearth of high-quality evidence on integrated, coordinated and cost-effective care for children with special health and care needs (CSHCN).</p><p><strong>Objective: </strong>To assess the effectiveness of integrated/coordinated care models for CSHCN.</p><p><strong>Data sources: </strong>Embase, Ovid Medline(R), HMIC Health Management Information Consortium, Maternity & Infant Care Database (MIDIRS), PsycARTICLES, PsycINFO, Social Policy and Practice, Cochrane Central Register of Controlled Trials (CENTRAL), Global Health and PubMed.</p><p><strong>Study selection: </strong>Inclusion criteria comprised (1) randomised trials, including cluster randomised trials; (2) an integrated/coordinated care intervention; (3) for children and young people under 25 with special healthcare needs including medical complexity; (4) assessing child-centred outcomes, health-related quality of life among parents and carers, and health or social care use, processes of care and satisfaction with care.</p><p><strong>Data extraction: </strong>Data were extracted and assessed by two researchers, and descriptive data were synthesised according to outcome and intervention.</p><p><strong>Results: </strong>14 randomised controlled studies were included. 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Integrated care for children and young people with special health and care needs: a systematic review.
Context: There is a dearth of high-quality evidence on integrated, coordinated and cost-effective care for children with special health and care needs (CSHCN).
Objective: To assess the effectiveness of integrated/coordinated care models for CSHCN.
Data sources: Embase, Ovid Medline(R), HMIC Health Management Information Consortium, Maternity & Infant Care Database (MIDIRS), PsycARTICLES, PsycINFO, Social Policy and Practice, Cochrane Central Register of Controlled Trials (CENTRAL), Global Health and PubMed.
Study selection: Inclusion criteria comprised (1) randomised trials, including cluster randomised trials; (2) an integrated/coordinated care intervention; (3) for children and young people under 25 with special healthcare needs including medical complexity; (4) assessing child-centred outcomes, health-related quality of life among parents and carers, and health or social care use, processes of care and satisfaction with care.
Data extraction: Data were extracted and assessed by two researchers, and descriptive data were synthesised according to outcome and intervention.
Results: 14 randomised controlled studies were included. Seven out of the 14 studies had a dedicated key worker/care coordinator as a vital part of the integrated/coordinated care intervention; however, the certainty of evidence for all outcomes was either 'low' or 'very low'.
Limitations: Included studies were mostly from high-income countries. Variable study outcomes and quality of evidence precluded meta-analysis.
Conclusions: Limited evidence favours integrated care for CSHCN using a dedicated key worker/care coordinator; however, heterogeneity in study outcomes and definitions of CSHCN limit the strength and utility of evidence obtained. Recommendations are made for improving integrated care practice, research and evaluation which are important for evidence-based health services for CSHCN.
期刊介绍：
Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.
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