Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis.
Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis.
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DOI：
10.1136/bmj.b2732
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发表时间：
2009-08-04
期刊：
影响因子：
--
通讯作者：
Guyatt GH
中科院分区：
文献类型：
--
作者：
Comondore VR;Devereaux PJ;Zhou Q;Stone SB;Busse JW;Ravindran NC;Burns KE;Haines T;Stringer B;Cook DJ;Walter SD;Sullivan T;Berwanger O;Bhandari M;Banglawala S;Lavis JN;Petrisor B;Schünemann H;Walsh K;Bhatnagar N;Guyatt GH
目的比较营利性和非营利性养老院的护理质量。设计对观察性研究和随机对照试验进行系统回顾和荟萃分析，调查营利性与非营利性养老院的护理质量。结果综合检索得到8827篇引文，其中956篇被认为适合全文审阅。总结了82篇符合纳入标准的研究特征和结果，并汇总了四种最常报道的质量测量的结果。纳入的研究报告的结果可追溯到1965年至2003年。在40项研究中，所有具有统计学意义的比较（P<0.05）都倾向于非营利性设施；在三项研究中，所有具有统计意义的比较都倾向于营利性设施，其余研究的结果不太一致。荟萃分析表明，在四项最常报道的质量指标中，非营利机构提供的护理质量高于营利性机构的两项：更多或更高质量的人员配备（效应比1.11,95%置信区间1.07至1.14，P<0.001）和更低的压疮患病率（优势比0.91,95%置信区间0.83至0.98，P=0.02）。非营利性家庭在另外两种最常用的措施中发现了非显著结果：物理约束的使用（优势比0.93,0.82至1.05，P=0.25）和较少的政府监管评估缺陷（效果比0.90,0.78至1.04，P=0.17）。结论：对证据的系统回顾和荟萃分析表明，平均而言，非营利性养老院比营利性养老院提供更高质量的护理。然而，就个别机构而言，许多因素可能影响这种关系。
Objective To compare quality of care in for-profit and not-for-profit nursing homes. Design Systematic review and meta-analysis of observational studies and randomised controlled trials investigating quality of care in for-profit versus not-for-profit nursing homes. Results A comprehensive search yielded 8827 citations, of which 956 were judged appropriate for full text review. Study characteristics and results of 82 articles that met inclusion criteria were summarised, and results for the four most frequently reported quality measures were pooled. Included studies reported results dating from 1965 to 2003. In 40 studies, all statistically significant comparisons (P<0.05) favoured not-for-profit facilities; in three studies, all statistically significant comparisons favoured for-profit facilities, and the remaining studies had less consistent findings. Meta-analyses suggested that not-for-profit facilities delivered higher quality care than did for-profit facilities for two of the four most frequently reported quality measures: more or higher quality staffing (ratio of effect 1.11, 95% confidence interval 1.07 to 1.14, P<0.001) and lower pressure ulcer prevalence (odds ratio 0.91, 95% confidence interval 0.83 to 0.98, P=0.02). Non-significant results favouring not-for-profit homes were found for the two other most frequently used measures: physical restraint use (odds ratio 0.93, 0.82 to 1.05, P=0.25) and fewer deficiencies in governmental regulatory assessments (ratio of effect 0.90, 0.78 to 1.04, P=0.17). Conclusions This systematic review and meta-analysis of the evidence suggests that, on average, not-for-profit nursing homes deliver higher quality care than do for-profit nursing homes. Many factors may, however, influence this relation in the case of individual institutions.
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发表时间：
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影响因子：
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