“去实施”的概念分析及研究现状

Concept analysis and research progress of de-implementation

目的分析“去实施”的定义和内涵,为“去实施”的研究和临床实践提供理论基础。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、万方数据库中“去实施”的相关文献,检索时限为建库至2022年7月。最终纳入文献40篇。采用Walker和Avant概念分析法进行概念分析,从“去实施”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“去实施”包括以低价值护理为对象、使用相应的策略、包含4种类型和过程复杂4个定义属性;前置因素包含低价值护理因素、卫生保健服务系统因素、患者因素、伦理因素和社会因素;后置影响包括对患者的影响和对卫生保健系统的影响。结论目前“去实施”研究仍处于初级阶段,尚缺少相关测量工具,未来应基于“去实施”的内涵进行研究和开展临床实践。

Objective To analyze the definition of de-implementation,and provide a theoretical basis for research and clinical practice.Methods Pubmed,ProQuest,CINAHL,CNKI,Wanfang,VIP,and China Biomedical Literature Service System databases were searched.The search time limit was from the establishment of the database to July 2022.As a result,40 articles were selected for analysis.Walker and Avant′s methods were used to perform concept analysis of de-implementation in terms of its definition,pre-factors,post-results.Results De-implementation can be classified into 4 defined attributes:low-value care as the subjects;strategies to apply;4 types of removing,replacing,reducing,restricting;complicated process.The pre-factors can be discussed from the aspects of low-value care,health care systems,patients,ethical and social factors.De-implementation can impact to patients and health care systems.Conclusions The research on de-implementation is still at an early stage.There is a lack of relevant measurement tools for the accurate determination of de-implementation.In the future,research and clinical practice should be carried out based on the concept of de-implementation.