中国医疗领域的循证实践：实时范围综述

Abstract

Background

Evidence-based practice (EBP) implementation plays a crucial role in bridging the knowledge-action gaps and reducing health inequities. Little is known about its development in China. This study aims to provide an overview of the EBP implementation research progress in healthcare in China and identify gaps for future studies.

Methods

We conducted a scoping review following the Joanna Briggs Institute scoping review methodology and the Cochrane Collaboration's guidance on living reviews. We performed a literature search in four Chinese databases (i.e., China National Knowledge Infrastructure, Wan Fang Database, The VIP Database, and China Biology Medicine) and three English databases (i.e., Ovid MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, and EMBASE), Google scholar, and Baidu scholar from 1996 to 2021. We included EBP implementation studies conducted in healthcare settings in China and were published in Chinese and English literature. The search will be run on a regular basis to monitor the development of new literature and determine when to update the review.

Findings

Of the 11,276 records identified, we finally included 309 papers. The publications were on a sharp rise since 2013 and were predominantly from the nursing field (292/309, 94.50%). The commonly researched areas were symptom management (75/309, 24.27%), tube care (46/309, 14.89%), perioperative care (43/309, 13.92%), and fundamental care (43/309, 13.92%). Joanna Briggs Institute model was the most frequently used model to guide the implementation process (92/159, 59.75%). A median number of 8 people often comprised an implementation team, with 113 studies (36.57%) taking a multidisciplinary approach. 204 studies reported utilizing audit criteria to assist evaluation of evidence implementation rate with diversified methods measuring the criteria. Lack of knowledge, skills, and resources, and incomplete procedures or pathways were top barriers impeding EBP implementation. Leadership support was considered the most common facilitator. Education and training were the most frequently described implementation strategies for healthcare professionals and patients. Optimizing workflows and developing evaluation tools were the primary strategies adopted by organizations. 291 studies measured patient outcomes and 174 studies measured healthcare professional outcomes.

Interpretation

To our knowledge, this scoping review is the first one to systematically examine the EBP implementation research progress in healthcare in China. Based on this review, we identified contributions that Chinese EBP implementation research made to the global community, and provided eight recommendations for Chinese researchers in conducting implementation studies in the future.

Funding

Virginia Commonwealth University College of Health Professions (VCUCHPSEED2021).

翻译（仅供参考）

背景介绍

       循证实践（EBP）的实施在弥合知识与行动的差距和减少健康不平等方面起着关键作用。但中国在这方面的发展却鲜为人知。本研究旨在概述中国医疗卫生领域的EBP实施研究进展，并找出未来研究的不足之处。

研究方法

       我们按照Joanna Briggs研究所的范围审查方法和Cochrane合作组织的活体审查指南进行了范围审查。我们在四个中文数据库（即中国国家知识基础设施、万方数据库、VIP数据库和中国生物医学）和三个英文数据库（即Ovid MEDLINE、Cumulative Index to Nursing and Allied Health Literature和EMBASE）、谷歌学者和百度学者进行了1996年至2021年的文献检索。我们纳入了在中国医疗环境下进行的EBP实施研究，并且是以中文和英文文献发表的。检索将定期进行，以监测新文献的发展，并决定何时更新评论。

研究结果

       在所发现的11276条记录中，我们最终收录了309篇论文。自2013年以来，这些出版物呈急剧上升趋势，主要来自护理领域（292/309，94.50%）。常见的研究领域是症状管理（75/309，24.27%）、管道护理（46/309，14.89%）、围手术期护理（43/309，13.92%）和基础护理（43/309，13.92%）。Joanna Briggs研究所模式是指导实施过程中最经常使用的模式（92/159，59.75%）。实施团队的中位数为8人，有113项研究（36.57%）采用了多学科的方法。204项研究报告了利用审计标准来协助评估证据实施率，并采用了不同的方法来衡量这些标准。缺乏知识、技能和资源，以及不完整的程序或途径是阻碍EBP实施的首要障碍。领导支持被认为是最常见的促进因素。教育和培训是医护人员和患者最常描述的实施策略。优化工作流程和开发评估工具是各机构采取的主要策略。291项研究测量了患者的结果，174项研究测量了医护人员的结果。

解读

       据我们所知，本综述是第一个系统地研究中国医疗卫生领域EBP实施研究进展的综述。在此基础上，我们确定了中国EBP实施研究对全球社区的贡献，并为中国研究人员未来开展实施研究提供了八项建议。

原文链接：

https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(21)00264-9/fulltext

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