出院计划实施质量评价指标的范围综述

doi:10.3761/j.issn.0254-1769.2021.04.023

摘要/Abstract

摘要：

目的对出院计划相关文献进行范围审查,以明确国内外出院计划实施质量评价指标、评价时机,及指标对应的评价工具,探索国内外出院计划实施质量评价指标的差异性。方法聚焦出院计划评价指标,系统检索中英文数据库和相关指南、政府网站,提取汇总内容包括：研究主题、研究类型、作者/机构、年份、国家、评价指标、适用对象、评价时机、指标收集方法和指标对应的评价工具。检索时间为2020年2月24日,检索近10年文献。结果以利益相关者为分类依据,将出院计划实施质量评价指标分为患者相关、医疗机构相关、照护者相关3大类,共纳入167篇文献,共计26项指标。其中患者相关评价指标12项,出现频率最高的前5项为再入院率、满意度、生活质量、自我照护能力、病死率;医疗机构相关评价指标9项,出现频率最高的前3项为住院时长、门/急诊就诊次数、医疗服务费用;照护者相关评价指标5项,最常见的指标为照护者满意度。国内外出院计划实施质量排名前10的指标中再入院率、生活质量、自我照护能力、门/急诊就诊次数、日常生活活动能力5项指标在国内外文献中出现的频次差异具有统计学意义（P<0.05）。结论建议医疗卫生机构在监测患者结局指标的基础上,兼顾医疗机构及照护者相关指标的监测,同时统一核心评价指标及对应测量工具,遴选敏感性评价指标,逐步开发可依靠信息系统自动提取的评价指标。

关键词: 出院计划, 实施质量, 评价指标, 范围综述, 护理管理研究

Abstract:

Objective We conducted a scoping review to systematically review the literature reporting discharge planning,and identify the quality evaluation indicators and its collection time,along with related tools. Then the differences between the quality evaluation indicators for discharge planning at home and abroad were explored. Methods Focusing on the quality evaluation indicators for discharge planning,we systematically searched the relevant databases,guidelines and government websites. The information,including research topic,research type,the first author/institution,year of publication,country,evaluation indicator,participants,collection time and method,evaluation tool,were also extracted and summarized. Results The quality evaluation indicators for discharge planning were divided into 3 dimensions,namely patient-related indicators,medical institution-related indicators,and caregiver-related indicators. A total of 167 papers were included and 26 indicators were extracted. There were 12 patient-related indicators,and the top 5 were readmission rate,patient satisfaction,quality of life,self-care ability and mortality. There were 9 medical institution-related indicators,and the top 3 were length of stay in hospital,frequency of outpatient/emergency visits,and medical expenditure. There were 5 caregiver-related indicators,the most common of which is caregiver satisfaction. The readmission rate,quality of life,self-care ability,frequency of outpatient/emergency visits,and activities of daily living had statistically significant differences among the top 10 evaluation indicators for discharge planning at home and abroad. Conclusion The medical institutions should not only monitor patient outcome indicators,but also audit related indicators of medical institutions and caregivers. The researchers should also unify core evaluation indicators and corresponding measurement tools,select sensitivity indicators,develop indicators that can be extracted by using Electronic Information System in the future.

Key words: Discharge Planning, Implementation Quality, Evaluation Indicators, Scoping Review, Nursing Administration Research

乐霄,汪晖,王颖,王冰花,柯键,江雅倩,黄海珊,胡凯利. 出院计划实施质量评价指标的范围综述[J]. 中华护理杂志, 2021, 56(4): 611-617.

YUE Xiao,WANG Hui,WANG Ying,WANG Binghua,KE Jian,JIANG Yaqian,HUANG Haishan,HU Kaili. The quality evaluation indicators for discharge planning：a scoping review[J]. Chinese Journal of Nursing, 2021, 56(4): 611-617.

图/表 6

图1 文献筛选的流程图

Figure 1 Flow chart of literature screening

表1 出院计划实施质量评价指标范围综述纳入文献总体分布情况（n=167）

Table 1 Overall distribution of the quality evaluation indicators for discharge planning（n=167）

表2 出院计划实施质量患者相关评价指标

Table 2 Patient-related quality evaluation indicators for discharge planning

表3 出院计划实施质量医疗机构相关评价指标

Table 3 Medical institution-related quality evaluation indicators for discharge planning

表4 出院计划实施质量家庭照护者相关评价指标

Table 4 Caregiver-related quality evaluation indicators for discharge planning

表5 频次排名前10位的出院计划实施质量评价指标国内外差异分析

Table 5 The differences between the top 10 quality evaluation indicators for discharge planning at home and abroad

参考文献 34

[1]	王冰花, 汪晖, 王颖, 等. 湖北省19所三级医院出院计划开展现况调查[J]. 护理学杂志, 2019,34(23):46-50.
	Wang BH, Wang H, Wang Y, et al. Current status of discharge planning in 19 tertiary hospitals in Hubei Province[J]. J Nurs Sci, 2019,34(23):46-50.
[2]	孙超, 奚桓, 李峥, 等. 老年患者出院准备服务专家共识(2019版)[J]. 中华护理杂志, 2020,55(2):220-227.
	Sun C, Xi H, Li Z, et al. Expert consensus on the discharge planning for hospitalized elderly patients(Edition 2019)[J]. Chin J Nurs, 2020,55(2):220-227.
[3]	Health Service Executive. Integrated Care Guidance：a practical guide to discharge and transfer from hospital[EB/OL].（2014-03）[2020-03-20]. https://www.hse.ie/eng/about/who/qid/resourcespublications/nationalintegratedcareguidance.pdf.
[4]	National Institute for Health and Care Excellence. Transition between inpatient hospital settings and community or care home settings for adults with social care needs（QS136）[EB/OL]. （2016-12）[2020-03-20]. https://www.nice.org.uk/guidance/qs136.
[5]	Centers for Medicare & Medicaid Services. Revision to State Operations Manual（SOM）,Hospital Appendix A-Interpretive Guidelines for 42 CFR 482.43,Discharge Planning[EB/OL].（2013-05-17）[2020-03-20]. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-13-32.
[6]	柯丽清. 出院计划对脑卒中吞咽障碍患者护理效果的影响[D]. 福州:福建中医药大学, 2016. DOI URL PMID
	Ke LQ. Influence of discharge planning on nursing effect of stroke patients with dysphagia[D]. Fuzhou:Fujian University of Traditional Chinese Medicine, 2016. DOI URL PMID
[7]	易银萍. 基于聚焦解决模式的出院计划在慢性心力衰竭患者中的应用研究[D]. 成都:成都中医药大学, 2018. DOI URL PMID
	Yi YP. A study of application on discharge planning based on solution focused approach for the patients with chronic heart failure[D]. Chengdu:Chengdu University of Traditional Chinese Medicine, 2018. DOI URL PMID
[8]	陈琴, 姜小鹰, 钟清玲, 等. 慢性阻塞性肺疾病患者应用出院计划服务的效果评价[J]. 中华护理杂志, 2012,47(9):790-794.
	Chen Q, Jiang XY, Zhong QL, et al. Effect of discharge planning services in patients with chronic obstructive pulmonary disease[J]. Chin J Nurs, 2012,47(9):790-794.
[9]	Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews(PRISMA-ScR):checklist and explanation[J]. Ann Intern Med, 2018,169(7):467-473. DOI URL PMID
[10]	周芬, 郝玉芳, 丛雪, 等. 指南研究与评价工具AGREE II及各领域分值的补充解释及思考[J]. 护理学报, 2018,25(18):61-63.
	Zhou F, Hao YF, Cong X, et al. Guidelines research and the supplementary explanation and thinking of AGREE Ⅱ each domain score[J]. J Nurs, 2018,25(18):61-63.
[11]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018: 56-83.
	Hu Y, Hao YF. Evidence-based nursing[M]. 2nd Ed. Beijing: People’s Medical Publishing House, 2018: 56-83.
[12]	Gonçalves-Bradley DC, Lannin NA, Clemson LM, et al. Discharge planning from hospital[J]. Cochrane Database Syst Rev, 2016(1):CD000313. DOI URL PMID
[13]	陈丽. 我国再入院率衡量住院医疗服务质量的适用性分析[J]. 中国医院管理, 2016,36(1):48-50.
	Chen L. Applicability analysis of employ readmission rate to evaluate the quality of inpatient healthcare in China[J]. Chin Hosp Manag, 2016,36(1):48-50.
[14]	Mabire C, Dwyer A, Garnier A, et al. Meta-analysis of the effectiveness of nursing discharge planning interventions for older inpatients discharged home[J]. J Adv Nurs, 2018,74(4):788-799. DOI URL PMID
[15]	Antunes B, Harding R, Higginson IJ. Implementing patient-reported outcome measures in palliative care clinical practice:a systematic review of facilitators and barriers[J]. Palliat Med, 2014,28(2):158-175. DOI URL PMID
[16]	Mennuni M, Massimo Gulizia M, Alunni G, et al. ANMCO Position Paper:hospital discharge planning:recommendations and standards[J]. Eur Heart J Suppl, 2017,19(Suppl D):D244-D255. DOI URL PMID
[17]	Mabire C, Büla C, Morin D, et al. Nursing discharge planning for older medical inpatients in Switzerland:a cross-sectional study[J]. Geriatr Nurs, 2015,36(6):451-457. DOI URL PMID
[18]	Ingram JC, Powell JE, Blair PS, et al. Does family-centred neonatal discharge planning reduce healthcare usage? A before and after study in South West England[J]. BMJ Open, 2016,6(3):e010752. DOI URL PMID
[19]	Wales K, Salkeld G, Clemson L, et al. A trial based economic evaluation of occupational therapy discharge planning for older adults:the HOME randomized trial[J]. Clin Rehabilitation, 2018,32(7):919-929. DOI URL
[20]	Oh EG, Kim JH, Lee HJ. Effects of a safe transition pro-gramme for discharged patients with high unmet needs[J]. J Clin Nurs, 2019,28(11/12):2319-2328. DOI URL
[21]	Provencher V, Clemson L, Wales K, et al. Supporting at-risk older adults transitioning from hospital to home:who benefits from an evidence-based patient-centered discharge planning intervention Post-hoc analysis from a randomized trial[J]. BMC Geriatr, 2020,20(1):84. DOI URL PMID
[22]	罗冷. 支气管哮喘患儿个体化出院计划方案的构建及应用效果评价[D]. 太原:山西医科大学, 2018.
	Luo L. Construction and evaluation of individualized discharge planning in children with bronchial asthma[D]. Taiyuan:Shan-xi Medical University, 2018.
[23]	成磊, 陆春梅, 张玉侠, 等. 提升早产儿出院家庭准备度最佳循证实践方案的制订和应用[J]. 中华护理杂志, 2016,51(7):787-791.
	Cheng L, Lu CM, Zhang YX, et al. Facilitating family’s readiness for discharge of premature infants:development and implementation of an evidence-based protocol[J]. Chin J Nurs, 2016,51(7):787-791.
[24]	Chiang LC, Chen WC, Dai YT, et al. The effectiveness of telehealth care on caregiver burden,mastery of stress,and family function among family caregivers of heart failure patients:a quasi-experimental study[J]. Int J Nurs Stud, 2012,49(10):1230-1242. DOI URL
[25]	Altfeld SJ, Shier GE, Rooney M, et al. Effects of an enhanced discharge planning intervention for hospitalized older adults:a randomized trial[J]. Gerontol, 2013,53(3):430-440. DOI URL
[26]	Petitgout JM. Implementation and evaluation of a unit-based discharge coordinator to improve the patient discharge experience[J]. J Pediatr Heal Care, 2015,29(6):509-517.
[27]	卢珏. 出院计划对脑卒中患者主要照顾者需求满足的效果研究[D]. 苏州:苏州大学, 2013.
	Lu J. Effects of discharge planning for primary caregivers of stroke patient on need satisfaction[D]. Suzhou:Soochow University, 2013.
[28]	Pellett C. Discharge planning:best practice in transitions of care[J]. Br J Community Nurs, 2016,21(11):542-548. DOI URL PMID
[29]	Pedersen PU, Ersgard KB, Soerensen TB, et al. Effectiveness of structured planned post discharge support to patients with chronic obstructive pulmonary disease for reducing readmission rates:a systematic review[J]. JBI Database Syst Rev Imp-lement Rep, 2017,15(8):2060-2086.
[30]	Agency for Healthcare Research and Quality. Care transitions from hospital to home：IDEAL discharge planning[EB/OL].（2013-06）[2020-03-20]. https://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy4/index.html.
[31]	Fox MT, Persaud M, Maimets I, et al. Effectiveness of early discharge planning in acutely ill or injured hospitalized older adults:a systematic review and meta-analysis[J]. BMC Geriatr, 2013,13(1):1-9. DOI URL
[32]	Lambrinou E, Kalogirou F, Lamnisos D, et al. Effectiveness of heart failure management programmes with nurse-led discharge planning in reducing re-admissions:a systematic review and meta-analysis[J]. Int J Nurs Stud, 2012,49(5):610-624. DOI URL
[33]	王冰花, 汪晖, 杨纯子. 中文版出院指导质量量表的信效度测评[J]. 中华护理杂志, 2016,51(6):752-755.
	Wang BH, Wang H, Yang CZ. Reliability and validity of the Chinese version of the quality of Discharge Teaching Scale[J]. Chin J Nurs, 2016,51(6):752-755.
[34]	Johnston B, Flemming K, Narayanasamy MJ, et al. Patient reported outcome measures for measuring dignity in palliative and end of life care:a scoping review[J]. BMC Health Serv Res, 2017,17(1):574. DOI URL PMID