Core components and impact of nurse-led integrated care models for home-dwelling older people: A systematic review and meta-analysis

被引：49

作者：

Deschodt, Mieke ^{[1
,2
]}

Laurent, Gwen ^{[1
]}

Cornelissen, Lonne ^{[2
]}

Yip, Olivia ^{[1
]}

Zuniga, Franziska ^{[1
]}

Denhaerynck, Kris ^{[1
]}

Briel, Matthias ^{[3
,4
]}

Karabegovic, Azra ^{[5
]}

De Geest, Sabina ^{[1
,6
]}

Blozik, Eva ^{[7
]}

Jenkins, Rachel ^{[8
]}

Probst-Hensch, Nicole ^{[9
]}

Quinto, Carlos ^{[10
]}

Schwenkglenks, Matthias ^{[11
]}

Stenz, Samuel ^{[1
]}

Vounatsou, Penelope ^{[9
]}

Zeller, Andreas ^{[12
]}

Zullig, Leah ^{[13
]}

机构：

[1] Univ Basel, Dept Publ Hlth, Nursing Sci, Bernoullistr 28, CH-4056 Basel, Switzerland

[2] Katholieke Univ Leuven, Dept Publ Hlth & Primary Care, Gerontol & Geriatr, Herestr 49 ON1 Box 707, B-3000 Leuven, Belgium

[3] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, 1280 Main St West, Hamilton, ON, Canada

[4] Univ Basel, Univ Hosp Basel, Dept Clin Res, Schanzenstr 55, CH-4031 Basel, Switzerland

[5] Spitex Zurich Limmat AG, Fachentwicklung Chron Care Kompetenz, Zentrum Spitex Zurich, Rotbuchstr 46, CH-8037 Zurich, Switzerland

[6] Katholieke Univ Leuven, Dept Publ Hlth & Primary Care, Acad Ctr Nursing & Midwifery, Kapucijnenvoer 35 Blok d,Box 7001, B-7001 Leuven, Belgium

[7] Helsana Grp Zurich, Zurich, Switzerland

[8] Spitex Zurich Limmat AG, Zurich, Switzerland

[9] Swiss Trop & Publ Hlth Inst, Basel, Switzerland

[10] Arztegesell Baselland, Sissach, Switzerland

[11] Univ Basel, Dept Pharmaceut Sci, Basel Pharmacoepidemiol Unit, Basel, Switzerland

[12] Univ Basel, Ctr Primary Hlth Care, Basel, Switzerland

[13] Duke Univ, Sch Med, Dept Populat Hlth Sci, Durham, NC USA

来源：

INTERNATIONAL JOURNAL OF NURSING STUDIES | 2020年 / 105卷

基金：

瑞士国家科学基金会; 欧盟地平线“2020”;

关键词：

Activities of daily living; Community health nursing; Delivery of health care; integrated; Frail elderly; Health services for the aged; Meta-analysis; Patient-centred care; Quality of life; MULTIPLE CHRONIC CONDITIONS; FRAIL ELDERLY-PEOPLE; VISITING PROGRAM; CASE-MANAGEMENT; HEALTH-PROBLEMS; CLINICAL-TRIAL; IMPLEMENTATION; ADULTS; MULTIMORBIDITY; FRAGMENTATION;

D O I：

10.1016/j.ijnurstu.2020.103552

中图分类号：

R47 [护理学];

学科分类号：

1011 ;

摘要：

Background: Integrated care models are highly recommended to overcome care fragmentation in the multimorbid older population. Nurses are potentially ideally situated to fulfil the role as care coordinator to guide integrated care. No systematic review has been conducted specifically focusing on the impact of nurse-led integrated care models for older people in community settings. Objectives: To identify core components of nurse-led integrated care models for the home-dwelling older population; to describe patient, service and process outcomes; and to evaluate the impact of these care models on quality of life, activities of daily living, hospitalisation, emergency department visits, nursing home admissions and mortality. Design: Systematic review and meta-analysis. Data sources: English, Dutch, French, German and Spanish articles selected from PubMed and CINAHL, hand-search of reference lists of the included articles and grey literature. Review methods: A systematic search was conducted to identify prospective experimental or quasi-experimental studies detailing nurse-led integrated care models in the older home-dwelling population. Study characteristics and reported outcomes were tabulated. The core components of the models were mapped using the Sustainable intEgrated chronic care modeLs for multi-morbidity: delivery, Financing, and performancE (SELFIE) framework. A random effects meta-analysis was conducted to study the overall effectiveness of the included care models on health-related quality of life, activities of daily living, hospitalisation, emergency department visits, nursing home admissions or mortality. Risk of bias was appraised using the revised Cochrane risk-of-bias tool for randomized trials and ROBINS-I tool for non-randomized studies. Results: Nineteen studies were included studying a total of 22,168 patients. Core components of integrated care for multimorbid patients such as the involvement of a multidisciplinary team, high risk screening, tailored holistic assessment and an individualized care plan, were performed in a vast majority of the studies; however variability was observed in their operationalisation. Twenty-seven different patient, provider and service outcomes were reported, ranging from 1 to 13 per study. The meta-analyses could not demonstrate a beneficial impact on any of the predefined outcomes. Most included studies were of high risk for several biases. Conclusion: The summarized evidence on nurse-led integrated care models in home-dwelling older people is inconclusive and of low quality. Future studies should include key components of implementation research, such as context analyses, process evaluations and proximal outcomes, to strengthen the evidence-base of nurse-led integrated care. (C) 2020 Elsevier Ltd. All rights reserved.

引用

页数：12

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