Sanuri Wijesekera Kankanamge, Robyn Gallagher, Sherry L Grace, Ling Zhang, Michelle Cunich, Dion Candelaria
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引用次数: 0
摘要
目的：心脏康复（CR）项目的内容和交付仍然存在显著差异。质量改进干预措施加强了对标准的遵守并减少了可变性，但缺乏关于其在CR中的特点和有效性的综合证据。本荟萃分析旨在评估质量改进干预措施对CR过程和患者预后的影响。方法：检索2000年1月至2024年11月发表的文献，检索Scopus、CENTRAL、Medline、Embase和CINAHL。完成了冠状病毒的研究选择、数据提取和偏倚风险评估。在可能的情况下，使用RevMan v5.3，随机效应模型进行meta分析。不适合meta分析的结果以叙述方式报道。结果：纳入15项研究（76,856名受试者），包括1项随机对照试验、1项回顾性观察性研究和13项前后研究。对11项研究（17,010名受试者）的荟萃分析显示，质量改善干预显著改善了CR转诊(优势比[OR] 5.25；95%置信区间[CI] 3.11, 8.87)。从亚组分析来看，患者教育的影响最大(OR 8.37；95% CI 4.32, 16.21)，其次是技术(OR 5.56；95% CI 2.67, 11.58)和工艺变化(OR 5.31；95% ci 2.53, 11.12)。叙述性综合表明，质量改善干预导致出院至预约时间（1/1项研究）、出席率（3/4）、指南导向药物治疗处方（1/1）和完成率（1/1）的显著改善。很少有研究报告患者的预后。结论：质量改善干预措施可使CR转诊率提高8倍。虽然需要谨慎，但质量改进干预措施也可能降低等待时间，提高项目利用率。需要进一步的研究。注册：普洛斯彼罗ID: CRD42024557586。
Effectiveness of Quality Improvement Interventions in Cardiac Rehabilitation on Processes and Patient Outcomes: A Systematic Review and Meta-analysis.
Aims: Significant variability in Cardiac rehabilitation (CR) program content and delivery persists. Quality improvement interventions enhance adherence to standards and reduce variability, yet synthesized evidence of their characteristics and effectiveness in CR is lacking. This meta-analysis aimed to evaluate the effects of quality improvement interventions on CR processes and patient outcomes.
Methods: Scopus, CENTRAL, Medline, Embase, and CINAHL were searched for studies published from January, 2000 to November, 2024. Study selection in Covidence, data extraction and risk of bias assessment were completed. Where possible, meta-analyses were conducted using RevMan v5.3, random-effects model. Outcomes not suitable for meta-analysis were reported narratively.
Results: Fifteen studies (76,856 participants) were eligible, including one randomized controlled trial, one retrospective observational study, and 13 pre-post studies. Meta-analysis of 11 studies (17,010 participants) showed that quality improvement interventions significantly improved CR referral (odds ratio [OR] 5.25; 95% confidence interval [CI] 3.11, 8.87). From subgroup analyses, patient education had the largest effect (OR 8.37; 95% CI 4.32, 16.21), followed by technology (OR 5.56; 95% CI 2.67, 11.58) and process changes (OR 5.31; 95% CI 2.53, 11.12). Narrative synthesis indicated that quality improvement interventions led to significant improvements in time from discharge to scheduled appointment (1/1 studies), attendance (3/4), prescription of guideline-directed medical therapy (1/1), and completion (1/1). Few studies reported patient outcomes.
Conclusion: Quality improvement interventions improve referral to CR up to eight times. While caution is warranted, quality improvement interventions may also lower waits and increase program utilization. Future studies are needed.
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