Data_Sheet_5_Interventions to Prevent Potentially Avoidable Hospitalizations: A Mixed Methods Systematic Review.docx

BackgroundThe demand for healthcare is increasing due to an aging population, more people living with chronic diseases and medical comorbidities. To manage this demand, political institutions call for action to reduce the potentially avoidable hospitalizations. Quantitative and qualitative aspects should be considered to understand how and why interventions work, and for whom. The aim of this mixed methods systematic review was to identify and synthesize evidence on interventions targeting avoidable hospitalizations from the perspectives of the citizens and the healthcare professionals to improve the preventive healthcare services.
Methods and ResultsA mixed methods systematic review was conducted following the JBI methodology using a convergent integrated approach to synthesis. The review protocol was registered in PROSPERO, reg. no. CRD42020134652. A systematic search was undertaken in six databases. In total, 45 articles matched the eligibility criteria, and 25 of these (five qualitative studies and 20 quantitative studies) were found to be of acceptable methodological quality. From the 25 articles, 99 meaning units were extracted. The combined evidence revealed four categories, which were synthesized into two integrated findings: (1) Addressing individual needs through care continuity and coordination prevent avoidable hospitalizations and (2) Recognizing preventive care as an integrated part of the healthcare work to prevent avoidable hospitalizations.
ConclusionsThe syntheses highlight the importance of addressing individual needs through continuous and coordinated care practices to prevent avoidable hospitalizations. Engaging healthcare professionals in preventive care work and considering implications for patient safety may be given higher priority. Healthcare administers and policy-makers could support the delivery of preventive care through targeted educational material aimed at healthcare professionals and simple web-based IT platforms for information-sharing across healthcare settings. The findings are an important resource in the development and implementation of interventions to prevent avoidable hospitalizations, and may serve to improve patient safety and quality in preventive healthcare services.
Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=134652, identifier: CRD42020134652.

【背景】随着人口老龄化加剧，罹患慢性病与多种合并症的人群持续增多，医疗服务需求日益攀升。为应对这一供需压力，各国政治机构呼吁采取行动，减少潜在可避免住院的发生。要明晰干预措施的起效逻辑、作用原理与适用人群，需同时考量定量与定性研究维度。本混合方法系统综述旨在从公众与医护人员的视角，梳理并整合针对潜在可避免住院的干预措施相关证据，以优化预防医疗服务质量。

【方法与结果】本研究遵循乔安娜·布里格斯研究所（JBI）方法学框架，采用收敛整合式合成策略开展混合方法系统综述。本综述方案已在国际前瞻性系统评价注册平台（PROSPERO）注册，注册号为CRD42020134652。研究通过6个数据库进行系统性文献检索，最终纳入符合纳入标准的文献45篇，其中25篇（含5项定性研究与20项定量研究）的方法学质量可接受。从这25篇文献中共提取99个意义单元，经整合分析得到4个类别，并进一步归纳为2项综合结论：①通过照护连续性与协调性满足个体需求，可预防潜在可避免住院的发生；②将预防医疗视为医疗工作的有机组成部分，可有效减少潜在可避免住院。

【结论】本综述的整合结果凸显了通过持续性、协调性照护实践满足个体需求，对减少潜在可避免住院的重要意义。应进一步优先推动医护人员参与预防医疗工作，并关注其对患者安全的潜在影响。医疗管理者与政策制定者可通过针对医护人员的专项教育材料，以及用于跨医疗场景信息共享的简易Web端信息技术平台，支持预防医疗服务的开展。本研究结果可为潜在可避免住院预防干预措施的开发与实施提供重要参考，同时有助于提升预防医疗服务的患者安全性与服务质量。

【系统综述注册信息】https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=134652，标识符：CRD42020134652。