系统评价以确定代理指标，以量化电子健康工具对低收入和中等收入国家孕产妇和新生儿健康结局的影响，包括德尔菲共识法。
Systematic review to identify proxy indicators to quantify the impact of eHealth tools on maternal and neonatal health outcomes in low-income and middle-income countries including Delphi consensus.
作者信息
Perrin Caroline, Hounga Lothaire, Geissbuhler Antoine
机构信息
Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
出版信息
BMJ Open. 2018 Aug 17;8(8):e022262. doi: 10.1136/bmjopen-2018-022262.
OBJECTIVE
To identify interventions that could serve as reliable proxy indicators to measure eHealth impact on maternal and neonatal outcomes.
DESIGN
Systematic review and Delphi study.
METHODS
We searched PubMed, Embase and Cochrane from January 1990 to May 2016 for studies and reviews that evaluated interventions aimed at improving maternal/neonatal health and reducing mortality. Interventions that are not low-income and middle-income context appropriate and that cannot currently be diagnosed, managed or impacted by eHealth (eg, via telemedicine distance diagnostic or e-learning) were excluded. We used the Cochrane risk of bias, Risk Of Bias In Non- randomised Studies - of Interventions and ROBIS tool to assess the risk of bias. A three-step modified Delphi method was added to identify additional proxy indicators and prioritise the results, involving a panel of 13 experts from different regions, representing obstetricians and neonatologists.
RESULTS
We included 44 studies and reviews, identifying 40 potential proxy indicators with a positive impact on maternal/neonatal outcomes. The Delphi experts completed and prioritised these, resulting in a list of 77 potential proxy indicators.
CONCLUSIONS
The proxy indicators propose relevant outcome measures to evaluate if eHealth tools directly affect maternal/neonatal outcomes. Some proxy indicators require mapping to the local context, practices and available resources. The local mapping facilitates the utilisation of the proxy indicators in various contexts while allowing the systematic collection of data from different projects and programmes. Based on the mapping, the same proxy indicator can be used for different contexts, allowing it to measure what is locally and temporally relevant, making the proxy indicator sustainable.
PROSPERO REGISTRATION NUMBER
CRD42015027351.
目的
确定可作为可靠替代指标的干预措施，以衡量电子健康对孕产妇和新生儿结局的影响。
设计
系统评价和德尔菲研究。
方法
我们检索了1990年1月至2016年5月期间的PubMed、Embase和Cochrane数据库，查找评估旨在改善孕产妇/新生儿健康和降低死亡率的干预措施的研究和综述。排除那些不适用于低收入和中等收入环境且目前无法通过电子健康（如通过远程医疗远程诊断或电子学习）进行诊断、管理或产生影响的干预措施。我们使用Cochrane偏倚风险、非随机干预研究中的偏倚风险工具和ROBIS工具来评估偏倚风险。增加了一个三步改良德尔菲方法，以识别额外的替代指标并对结果进行排序，该方法涉及来自不同地区的13名专家组成的小组，代表产科医生和新生儿科医生。
结果
我们纳入了44项研究和综述，确定了40个对孕产妇/新生儿结局有积极影响的潜在替代指标。德尔菲专家完成了这些指标的筛选并进行了排序，得出了一份包含77个潜在替代指标的清单。
结论
这些替代指标提出了相关的结局测量方法，以评估电子健康工具是否直接影响孕产妇/新生儿结局。一些替代指标需要根据当地情况、实践和可用资源进行调整。这种本地化调整有助于在各种情况下利用替代指标，同时允许系统地收集来自不同项目和计划的数据。基于这种调整，相同的替代指标可用于不同情况，使其能够衡量当地和当时相关的情况，从而使替代指标具有可持续性。
PROSPERO注册号：CRD42015027351。
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