IF 2.8 Q1 ORTHOPEDICS Bone & Joint Open Pub Date : 2025-03-06 DOI:10.1302/2633-1462.63.BJO-2024-0104.R1
Veena Mazarello Paes, Andrew Ting, James Masters, Mahalia V I Paes, Elizabeth Tutton, Simon M Graham, Matthew L Costa
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摘要

目的:绩效指标越来越多地被用于评估为髋部骨折患者提供的医疗质量。本综述旨在了解世界各地使用的各种绩效指标及其定义方式:我们采用混合方法对髋部骨折护理中使用绩效指标的文献进行了系统回顾。我们通过 12 个电子数据库和其他来源检索了相关证据。混合方法评估工具用于评估符合纳入标准的研究的方法质量。在 PROSPERO(CRD42023417515)上注册了一套相关的系统综述方案:结果:共审查了 24,634 篇文章,其中 171 篇符合审查标准。纳入的研究设计各异,来自 34 个不同国家的不同医疗系统。大多数研究在欧洲高收入国家进行(118 项),其次是北美(33 项)、亚洲(21 项)、澳大利亚(10 项)和南美(2 项)。英国的研究数量最多(45 项)。在 171 项研究(小于 2000 名参与者)中,只有 7 项研究是在 10 个中低收入国家(LMIC)进行的。不同医疗保健系统报告的绩效指标存在差异,指标通常没有定义或定义模糊。例如,手术中的 "早期 "有多种定义,"动员 "的定义不同或缺失,髋部骨折护理中的 "老年矫形评估 "也各不相同。不过,有几项绩效指标很常见,包括手术时间(n = 142/171; 83%)、老年骨科复查(n = 30; 17%)、术后早期活动(n = 58; 34%)和骨健康评估(n = 41; 24%)。定性研究(n = 18)主要来自高收入国家和印度,提供了 192 名患者和 138 名医护人员在临床护理和康复路径中使用绩效指标的经验证据。主题包括在引入绩效指标的同时开展教育和培训的重要性、临床团队角色的明确性以及重组或整合护理路径的必要性:本次研究发现了大量与髋部骨折患者医疗服务相关的绩效指标。然而,这些指标的定义和阈值在不同研究和国家之间存在差异。来自低收入和中等收入国家的证据很少。定性和定量证据都表明,仍迫切需要进一步研究髋部骨折护理中绩效指标的使用和标准化及其对患者预后和经济成本的影响。
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Which performance indicators are used globally for evaluating healthcare in patients with a hip fracture? : a mixed methods systematic review.

Aims: Performance indicators are increasingly used to evaluate the quality of healthcare provided to patients with a hip fracture. The aim of this review was to map the variety of performance indicators used around the world and how they are defined.

Methods: We present a mixed methods systematic review of literature on the use of performance indicators in hip fracture care. Evidence was searched through 12 electronic databases and other sources. A Mixed Methods Appraisal Tool was used to assess methodological quality of studies meeting the inclusion criteria. A protocol for a suite of related systematic reviews was registered at PROSPERO (CRD42023417515).

Results: A total 24,634 articles were reviewed, of which 171 met the criteria of the review. Included studies were heterogenous in design and came from varied healthcare systems in 34 different countries. Most studies were conducted in high-income countries in Europe (n = 118), followed by North America (n = 33), Asia (n = 21), Australia (n = 10), and South America (n = 2). The highest number of studies in one country came from the UK (n = 45). Only seven of the 171 studies (< 2,000 participants) were conducted across ten low- and middle-income countries (LMICs). There was variation in the performance indicators reported from different healthcare systems, and indicators were often undefined or ambiguously defined. For example, there were multiple definitions of 'early' in terms of surgery, different or missing definitions of 'mobilization', and variety in what was included in an 'orthogeriatric assessment' in hip fracture care. However, several performance indicators appeared commonly, including time to surgery (n = 142/171; 83%), orthogeriatric review (n = 30; 17%), early mobilization after surgery (n = 58; 34%), and bone health assessment (n = 41; 24%). Qualitative studies (n = 18), mainly from high-income countries and India, provided evidence on the experiences of 192 patients and 138 healthcare professionals with regard to the use of performance indicators in clinical care and rehabilitation pathways. Themes included the importance of education and training in parallel with the introduction of performance indicators, clarity of roles with the clinical team, and the need for restructuring or integration of care pathways.

Conclusion: This review identified a large number of performance indicators related to the delivery of healthcare for patients with a hip fracture. However, their definitions and thresholds varied across studies and countries. Evidence from LMICs is sparse. Both qualitative and quantitative evidence indicates that there remains a pressing need for further research into the use and standardization of performance indicators in hip fracture care and their influence on patient outcomes and economic costs.

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来源期刊
Bone & Joint Open
Bone & Joint Open ORTHOPEDICS-
CiteScore
5.10
自引率
0.00%
发文量
0
审稿时长
8 weeks
期刊最新文献
Improving Consent in Trauma: Recall (ICIT: Recall) : a multicentre study protocol of consent for hip fractures. Does total hip arthroplasty benefit patients with minimal radiological osteoarthritis? The clinical outcomes of a hybrid-virtual infant hip clinic for the nonoperative treatment of developmental dysplasia of the hip : a quality improvement study. The role of diagnostic wrist arthroscopy in suspected scapholunate ligament injury : a cohort study of 324 patients. The health-economic burden of hip and knee periprosthetic joint infections in Europe : a comprehensive analysis following primary arthroplasty.
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