Health service organisation impact on lower extremity amputations in people with type 2 diabetes with foot ulcers: systematic review and meta-analysis.
Health service organisation impact on lower extremity amputations in people with type 2 diabetes with foot ulcers: systematic review and meta-analysis.
复制标题
DOI：
10.1007/s00592-020-01662-x
复制
发表时间：
2021-06
影响因子：
3.8
通讯作者：
de Lusignan S
中科院分区：
文献类型：
--
作者：
Meza-Torres B;Carinci F;Heiss C;Joy M;de Lusignan S
尽管有糖尿病足部溃疡和相关并发症的流行病学证据，但尚不清楚卫生保健系统的具体组织方面如何对其临床轨迹产生积极影响。我们的目的是评估护理的组织性方面对受足部溃疡影响的2型糖尿病患者的截肢率的影响。我们对1999年至2019年发表的科学文献进行了系统的综述，使用以下关键字作为搜索标准：2型糖尿病患者，被诊断为糖尿病足溃疡，采用特定过程和护理路径治疗，以及LEA作为主要结果。总体结果被报告为使用固定和随机效应模型获得的合并优势比和95%的可信区间。共有57项研究被发现符合条件，突出了以下安排：专门的团队、护理路径和方案、多学科团队以及综合干预。其中，有7项研究符合荟萃分析的条件。根据随机效应模型，包括四种安排中的任何一种的干预措施与任何类型的下肢截肢的风险降低29%相关(OR=0.71；95%CI 0.52-0.96)。当单独关注主要LEA时，效果更大，导致48%的风险降低(OR=0.52；95%CI 0.30-0.91)。具体的组织安排，包括多学科团队和护理路径，可以防止糖尿病和足部溃疡患者一半的截肢。需要使用标准化标准进行进一步研究，以调查成本效益，以促进更广泛地执行经改进的组织安排。同样，研究应该找出将证据转化为行动的具体障碍。这些可能是卫生系统一级的结构和程序，例如，具有适当技能的专业人员的可用性、补偿机制和明确的组织干预实施指南。网上版载有补充材料，可在10.1007/s00592-020-01662-x查阅。
Despite the evidence available on the epidemiology of diabetic foot ulcers and associated complications, it is not clear how specific organizational aspects of health care systems can positively affect their clinical trajectory. We aim to evaluate the impact of organizational aspects of care on lower extremity amputation rates among people with type 2 diabetes affected by foot ulcers. We conducted a systematic review of the scientific literature published between 1999 and 2019, using the following key terms as search criteria: people with type 2 diabetes, diagnosed with diabetic foot ulcer, treated with specific processes and care pathways, and LEA as primary outcome. Overall results were reported as pooled odds ratios and 95% confidence intervals obtained using fixed and random effects models. A total of 57 studies were found eligible, highlighting the following arrangements: dedicated teams, care pathways and protocols, multidisciplinary teams, and combined interventions. Among them, seven studies qualified for a meta-analysis. According to the random effects model, interventions including any of the four arrangements were associated with a 29% reduced risk of any type of lower extremity amputation (OR = 0.71; 95% CI 0.52–0.96). The effect was larger when focusing on major LEAs alone, leading to a 48% risk reduction (OR = 0.52; 95% CI 0.30–0.91). Specific organizational arrangements including multidisciplinary teams and care pathways can prevent half of the amputations in people with diabetes and foot ulcers. Further studies using standardized criteria are needed to investigate the cost-effectiveness to facilitate wider implementation of improved organizational arrangements. Similarly, research should identify specific roadblocks to translating evidence into action. These may be structures and processes at the health system level, e.g. availability of professionals with the right skillset, reimbursement mechanisms, and clear organizational intervention implementation guidelines. The online version contains supplementary material available at 10.1007/s00592-020-01662-x.
登录
查看更多内容
团队方法的价值与糖尿病足问题的临床途径相结合：临床评估。
影响因子：
--
作者：
Nather A;Siok Bee C;Keng Lin W;Xin-Bei Valerie C;Liang S;Tambyah PA;Jorgensen A;Nambiar A
通讯作者：
Nambiar A
影响因子：
3.7
作者：
Moher D;Shamseer L;Clarke M;Ghersi D;Liberati A;Petticrew M;Shekelle P;Stewart LA;PRISMA-P Group
通讯作者：
PRISMA-P Group
影响因子：
8.2
作者：
Holman, N.;Young, R. J.;Jeffcoate, W. J.
通讯作者：
Jeffcoate, W. J.
影响因子：
1.7
作者：
Cunningham, S. G.;Carinci, F.;Benedetti, M. Massi
通讯作者：
Benedetti, M. Massi
影响因子：
13.2
作者：
McMurray, SD;Johnson, G;McDougall, K
通讯作者：
McDougall, K