期刊文章患者和医疗服务提供者之间的电子症状报告以提高医疗服务质量:一项随机对照试验的系统回顾。第2部分:方法质量和效果%A Johansen,Monika Alise %A Berntsen,Gro K Rosvold %A Schuster,Tibor %A Henriksen,Eva %A Horsch,Alexander %+挪威综合护理和远程医疗中心，北挪威大学医院，Sykehusveien 23, pb35，特罗姆瑟，9038，挪威，47 906 84 407，monika.alise.johansen@telemed.no %K电子症状报告%K医患关系%K患者参与%K共享决策%K复查%K咨询%K监测%K自我管理%K偏差%D 2012 %7 03.10.2012 %9原创论文%J J Med Internet Res %G英文%X背景:我们分两部分对患者和提供者之间电子症状报告的随机对照试验(rct)进行了系统回顾，以提高医疗服务质量。第1部分回顾了患者群体的类型学、卫生服务创新和研究目标。确定了四个创新类别:咨询支持、临床医生支持的监测、临床医生支持的自我管理和治疗。目的:评价随机对照试验的方法学质量，并总结最佳方法学研究的效果和收益。方法:我们搜索Medline、EMBASE、psyinfo、Cochrane中央对照试验登记册和IEEE Xplore，查找1990年至2011年11月间发表在英文文章中的原创研究。根据Cochrane推荐标准判断偏倚风险和可行性，根据《改善健康的复杂干预措施设计与评价框架》评价理论证据和临床前试验。三位作者评估了偏倚风险，两位作者独立提取了效应数据。 Disagreement regarding bias assessment, extraction, and interpretation of results were resolved by consensus discussions. Results: Of 642 records identified, we included 32 articles representing 29 studies. No articles fulfilled all quality requirements. All interventions were feasible to implement in a real-life setting, and theoretical evidence was provided for almost all studies. However, preclinical testing was reported in only a third of the articles. We judged three-quarters of the articles to have low risk for random sequence allocation and approximately half of the articles to have low risk for the following biases: allocation concealment, incomplete outcome data, and selective reporting. Slightly more than one fifth of the articles were judged as low risk for blinding of outcome assessment. Only 1 article had low risk of bias for blinding of participants and personnel. We excluded 12 articles showing high risk or unclear risk for both selective reporting and blinding of outcome assessment from the effect assessment. The authors’ hypothesis was confirmed for 13 (65%) of the 20 remaining articles. Articles on self-management support were of higher quality, allowing us to assess effects in a larger proportion of studies. All except one self-management interventions were equally effective to or better than the control option. The self-management articles document substantial benefits for patients, and partly also for health professionals and the health care system. Conclusion: Electronic symptom reporting between patients and providers is an exciting area of development for health services. However, the research generally is of low quality. The field would benefit from increased focus on methods for conducting and reporting RCTs. It appears particularly important to improve blinding of outcome assessment and to precisely define primary outcomes to avoid selective reporting. Supporting self-management seems to be especially promising, but consultation support also shows encouraging results. %M 23032363 %R 10.2196/jmir.2216 %U //www.mybigtv.com/2012/5/e126/ %U https://doi.org/10.2196/jmir.2216 %U http://www.ncbi.nlm.nih.gov/pubmed/23032363