医务人员“共诊患者”网络研究的范围综述

Use of patient-sharing techniques to study healthcare provider networks: a scoping review

目的 对基于“共诊患者”关系建立的医务人员网络研究进行范围综述。方法 计算机检索PubMed、EMbase、Scopus、ProQuest、Web of Science Core Collection、ScienceDirect、SAGE、Wiley Online Library、Google Scholar、CNKI和WanFang Data数据库,搜集医务人员“共诊患者”网络的相关研究,检索时限均为建库至2021年7月31日。由2名研究者独立筛选文献、提取资料后,应用Arksey和O’ Malley的范围综述方法对纳入文献进行分析。结果 共纳入110个研究。其中70.0%发表于2016年及以后,78.2%开展于美国,96.4%采用二级数据(如医保报销数据),45.5%采用指数随机图模型等社会网络分析方法。就网络特征而言,43.6%的研究采用社会网络理论框架,网络节点类型以1-模为主(87.3%),在构建医务人员“共诊患者”网络时,64.5%的研究采用患者数量阈值为1。综合所有研究结果发现医务人员“共诊患者”网络受地理因素(距离远近等)、医疗机构特征(规模大小等)、医务人员特征(专业科室等)及患者特征等因素影响,并且与医疗服务质量、医疗费用具有相关性。结论 医务人员“共诊患者”网络研究在指导临床和卫生政策上具有重要意义,未来研究应考虑补充纵向设计的研究证据、扩大研究对象范围及完善“共诊患者”网络与健康相关结局关系的证据。

Objective To provide a scoping review of the healthcare provider patient-sharing network. Methods PubMed, EMbase, Scopus, ProQuest, Web of Science Core Collection, ScienceDirect, SAGE, Wiley Online Library,Google Scholar, CNKI and WanFang Data databases were electronically searched to collect studies on patient-sharing network of healthcare providers from inception to July 31, 2021. Two reviewers independently screened literature,extracted data and then Arksey and O ’Malley’s scoping review method was used to analyze the study. Results A total of 110 studies were included. In which, 70.0% were published in 2016 and later, 78.2% were carried out in the United States,96.4% used secondary data, and 45.5% adopted social network analysis methods such as exponential random graph model.In terms of network characteristics, 43.6% of the studies adopted the theoretical framework of social network theory, and the network node type was mainly 1-mode, accounting for 87.3%. When constructing the physician patient-sharing networks, 64.5% of the studies had a threshold of 1 patient. We also synthesized existing studies on patient-sharing networks of healthcare providers in the light of factors of networks and related outcomes. Conclusion The studies of healthcare provider patient-sharing network have potentials to improve clinical practice and health policies. Further studies should consider adopting longitudinal design to validate evidence of study, expanding the scope of study subjects except physicians and enriching the evidence of the relationship between network and health-related outcomes.