低价值护理的概念分析及研究现状

Concept analysis and research progress of low-value care

目的分析低价值护理的定义和内涵,为识别和去除低价值护理提供理论基础。方法系统检索PubMed、ProQuest、CINAHL、中国知网、中国生物医学文献服务系统、维普数据库、万方数据知识服务平台中低价值护理的相关文献,最终纳入文献35篇。采用Walker和Avant概念分析法进行概念分析,从低价值护理的定义属性、前置因素、后置影响等方面进行分析和整合。结果低价值护理包括证据证明无效、弊大于利、不具成本效益、不符合患者的价值观和偏好4个定义属性,其前置因素包含知识信念因素、治疗关系因素和资源经济因素。低价值护理会影响患者身体和心理状态,增加卫生保健系统的经济负担,占用高价值护理的时间和资源。结论目前低价值护理的研究仍处于初级阶段,缺少相关测量工具,未来应进一步对低价值护理进行多层次、多角度的研究。

Objective To analyze the definition of low-value care,and provide a theoretical basis to identify and eliminate low-value care.Methods Pubmed,ProQuest,CINAHL,CNKI,Wanfang,VIP,and China Biomedical Literature Service System databases were searched.As a result,35 articles were selected for analysis.Walker and Avant′s methods were used to perform concept analysis of low-value care in terms of its definition,pre-factors,post-results.Results Low-value care can be classified into 4 categories,including the intervention in which evidence confers no or very little benefit on patients,the intervention that harms outweigh benefits,the intervention without cost-effectiveness,and the care which hardly confirms to the values and preferences of patients.The pre-factors can be discussed from the aspects of knowledge belief,treatment relationship and resource economy.Low-value care adversely affects the physical and psychological conditions of patients,increases the economic burden of health care systems and occupies the time and resources from high-value care.Conclusion The research on low-value care is still at an early stage.There is a lack of relevant measurement tools for the accurate determination of low-value care.Further research on low-value care should be carried out from multi-perspectives in the future.