Meta-Analysis of the Intervention Effect of Nudge Strategy on Low-Value Medical Behavior
茹楠 1贾香平 1关瑜山 1吴华章 2孟朝琳1
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作者信息
1. 首都医科大学护理学院 北京 100069
2. 中国医科大学卫生事业管理教研室 辽宁 沈阳 110122
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摘要
目的 评价助推策略对医护人员低价值医疗行为的干预效果,为低价值医疗行为治理提供循证依据.方法 检索Cochrane Library、PubMed、Web of Science、CINAHL、Embase、中国知网、万方、维普等数据库建库至2023年12月1日收录的助推策略减少医护人员低价值医疗行为的随机对照试验.采用RevMan 5.4和Stata 16.0软件进行Meta分析.结果 纳入8篇文献.助推策略可有效降低医护人员低价值医疗行为发生率(OR=0.60,95％CI[0.45,0.80],P<0.001).其中,干预时间<12个月、以医护人员为干预单元、多种联合的助推策略对低价值医疗行为的干预效果更佳,且助推策略对低价值抗生素处方和低价值影像学检查的干预效果差异具有统计学意义(P<0.05).结论 助推策略对减少低价值医疗行为具有一定效果.我国学者可借鉴国外成功经验,通过本土化创新,探索出适合我国医疗卫生服务体系的针对不同类型低价值医疗行为的治理策略.
Abstract
Objective To evaluate the intervention effect of nudge strategy on low-value medical behavior of medi-cal staff,and to provide evidence-based basis for the governance of low-value medical behavior . Methods Co-chrane Library,PubMed,Web of Science,CINAHL,Embase,CBM,CNKI,Wanfang,VIP and other databases were searched for randomized controlled trials on reducing low-value medical behavior of medical staff by nudge strategy from the establishment of the database to December 1,2023. Meta-analysis was performed using RevMan 5.4 and Stata 16.0 software. Results A total of 8 articles were included. Nudge strategy could effectively reduce the incidence of low-value medical behavior of medical staff ( OR=0.60,95％ CI[0.45,0.80],P<0.001) .Among them,the in-tervention time<12 months,the medical staff as the intervention unit,and a variety of combined nudge strategy had a better effect on reducing low-value medical behavior,and the difference in the intervention effect of the nudge strategy on low-value antibiotic prescriptions and low-value imaging examinations was statistically significant(P<0.05).Conclusion The nudge strategy has a certain effect on reducing low-value medical behavior. Chinese scholars can learn from the excellent experience of foreign countries and explore the governance strategies for different types of low-value medical service projects suitable for medical and health service system of China through localized innovation.
维普
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