国外居家医疗研究热点与前沿分析

背景　中国老年人口基数大，人口老龄化进程快，缺少应对老龄化的顶层设计，战略规划相对滞后，失能、慢性病人口负担严重，以医院为中心的医疗体系已经无法满足社会的需要。相较于中国老龄人口、失能人口、慢性病人口的迅猛增长，我国居家医疗的发展相对迟缓和落后。目的　分析国外居家医疗近十年的研究现状，以期了解居家医疗相关文献研究热点、关注焦点，探讨其现状，展望发展方向。方法　于2019-08-14，以“home-based care”为主题词，检索Web of Science 核心数据库（WoSCC）发表的居家医疗相关文献，检索年限为2010-2019年（截止日期2019-08-14），采用Web of Science和CiteSpace进行文献检索结果分析、文献共被引分析及关键词的共现分析。结果　共纳入3 216篇居家医疗相关文献。2010-2019年，居家医疗相关文献量逐年增加，其中美国的发文量最多，为1 311篇（40.8%）；排在前3位的研究领域为：医疗保健服务（549篇）、公共环境职业健康（420篇）、老年病学（409篇）；文献共被引分析得到5个聚类：心力衰竭（heart failure）、质性研究（qualitative study）、研究方案（study protocol）、乳腺癌患者（breast cancer patient）及居家姑息护理（home-based palliative care）；关键词共现分析发现，护理出现频次最高（395次），生活质量出现频次次之（325次），艾滋病作为关键词突显性最高；关键词中心性排名前3位的分别为随机对照试验（0.85）、疾病管理（0.73）、居家干预（0.71）。结论　居家医疗研究主题呈现多样化的特点，涉及范围广泛，主要关注老年人生活质量、艾滋病咨询、居家姑息护理、居家服务花费以及心力衰竭家庭康复。国外居家医疗研究全面，不断探索发展模式，整个发展过程相对健全稳定且持续高速。相对来说，我国的居家医疗发展尚处探索和学习阶段。分析文献可以看出居家医疗在改善居家患者生活质量、医疗成本、慢性病康复以及艾滋病的咨询与检测上有重要作用。

Citespace-based Visual Analysis of Overseas Research Frontiers and Hot Spots about Home-based Care

Background In China,a country with huge elderly population,accelerated population aging and heavy burden caused by disabilities and chronic diseases,there is a lack of top-level design to cope with aging and the strategic planning is relatively backward.Moreover,hospital-centered medical system can not meet people’s healthcare needs.Furthermore,home-based care is still backward and develops relatively slowly in contrast to rapid growth of elderly population,population with disabilities and chronic disease population.Objective To analyze the overseas research frontiers on home-based care in the past 10 years,to identify the research hotspots and frontiers as well as prospect of home-based care.Methods On August 14,2019,using"home-based care"as the subject heading,the database of Web of Science Core Collection was searched for studies regarding home-based care published from 2010 to August 14,2019.Web of Science-and Cite Space-based analyses,and cocitation analysis of the included studies,as well as co-occurrence analysis of the keywords were performed.Results Overall,3216 studies were included,1311(40.8%)of them were published in the United States,accounting for the largest proportion of the total.The studies showed a trend of annual increase during this period.The top 3 research fields were health care services(549 studies),public environment&occupational health(420 studies),and geriatrics(409 studies).5 co-citation clusters were derived:heart failure,qualitative study,study protocol,breast cancer patient,and home-based palliative care.Co-concurrence network analysis identified"quality of life"(325 times)as the second high-frequency keywords,next to"care"(395 times).And"AIDS"had the strongest citation burst.The top 3 key words The top three keywords with highest centrality value were"randomized controlled trial"(0.85),"disease management"(0.73),and"home-based intervention"(0.71).Conclusion The overseas research topics of home-based care involving multiple fields,mainly focus on quality of life in elderly people,AIDS counselling,home-based palliative care,cost,and home-based heart failure rehabilitation.In a word,overseas research on home-based care is comprehensive,showing a sound and stable as well as constant rapid development,in particular,its development models are constantly being explored.In contrast,home-based care in China is still in the exploratory phase,needing to learn advanced experiences from other countries.Literature review may find that home-based care plays an important role in improving patients’quality of life,chronic diseases rehabilitation,AIDS counseling and testing,and reducing medical cost.