目的：
多專業照護（multidisciplinary care, MDC）介入成效在許多慢性腎臟病研究中仍有不一致的結果，本研究目的為探討多專業照護對慢性腎臟病患者住院天數、死亡率與腎功能的成效。
方法：
本研究運用系統性文獻回顧與統合分析法，搜尋1993年1月至2009年12月發表之中英文文獻，以電子資料庫查詢台灣期刊論文索引系統、台灣博碩士論文知識加值系統、中文電子期刊服務、中文電子學位論文服務、Cumulative index to Nursing and Allied Health Literature（CINAHL）、The Cochrane Library、Medline、PubMed and ProQuest Dissertations and Themes共9種國內外資料庫，使用關鍵字為慢性腎臟病、慢性腎功能不全、慢性腎衰竭、多專業照護、透析前照護、透析前教育、住院天數、死亡率與腎功能。並逐一檢視所有選取文獻與相關文獻的參考書目。研究選取的標準為：（1）18歲以上成人，並被診斷為慢性腎臟病患者，且於進行腎臟替代療法（renal replacement therapy, RRT）前接受多專業照護者；（2）多專業照護係指由腎臟專科醫師、護理人員、營養師與社工人員共同組成，且於研究中有詳述流程；（3）研究中有包含任一項成果指標之探討。本研究選取高品質評價之文章進行分析，資料登錄內容包含研究特徵、樣本特徵、方法與介入特徵和統計相關資料，並使用comprehensive meta-analysis（CMA）第二版統計軟體，並以Chochrane Q與I2計算研究間的異質性分析，若所選取研究為同質性，則結果將採固定模式（fix model）解釋。
結果：
符合本研究之文章共有7篇（1330位病患），結果顯示介入多專業照護比起未介入組能減少住院天數（ES：- 0.60；95% CI為0.02, - 0.86；Z = - 4 .56；p = 0.00）與降低71%的死亡率（OR：0.29；95% CI為0.18, 0.45；Z = - 5.37；p = 0.00），在慢性腎臟病患者首次透析時的腎功能差異上，呈現介入組較控制組為低（ES：- 0.28；95% CI為- 0.55, - 0.02；Z = - 2.08；p = 0.04）。
結論：
應用多專業照護介入慢性腎臟病患可減少住院天數並降低死亡率。因此，多專業照護應成為慢性腎臟病防制策略中重要的一環。

Purpose:
Multidisciplinary care (MDC) in chronic kidney disease (CKD) has been evaluated in various studies, but its effectiveness has inconsistent results. The purpose of this study was to determine the effect of MDC on hospital days, all cause mortality and renal function among patients with CKD.
Method:
This research was a systematic review study with meta-analysis technique. Literature was retrieved from 1993 through 2009. Databases included PerioPath (Index to Taiwan Periodical Literature System), National Digital Library of Theses and Dissertations in Taiwan (NDLTD), Chinese Electronic Periodical Services (CEPS), Chinese Electronic Theses & Dissertations Service (CETD), Cumulative index to Nursing and Allied Health Literature (CINAHL), The Cochrane Library, Medline, PubMed, and ProQuest Dissertations and Themes. Keywords included chronic kidney disease, chronic renal insufficiency, chronic renal failure, multidisciplinary care, pre-dialysis care, pre-dialysis education, hospital days, mortality, and renal function. All reference lists, including studies and related articles, were checked after selection based on title and abstract.
Studies were included if they contained (1) adult patients over 18 years old who diagnosed as chronic kidney disease and attended MDC before renal replacement therapy (RRT); and (2) MDC was consisted by nephrologist, nurse, dietician, and social worker, and MDC protocol was described clearly in studies; and (3) study included one of the interest measures.
RCT or non-RCT studies with a high quality rating were included. Data on characteristics of the study, subjects, intervention and statistic results were extracted using standardized form. All data were calculated by comprehensive meta-analysis software. The Chochrane Q and I2 were used to examine heterogeneity between studies. The outcome results were combined using fix model if they were homogeneity.
Results:
Seven studies fulfilled inclusion criteria. There was significant effect in reduce hospital days (ES: - 0.60; 95% CI, 0.02 to - 0.86; Z = - 4.56, p = 0.00) and 71% mortality rate (OR：0.29；95% CI, 0.18 to 0.45; Z = -5.37; p = 0.00) in intervention group. There was significant lower renal function in the intervention group as compared with the usual care (ES：- 0.28; 95% CI, -0.55 to -0.02; Z = -2.08; p = 0.04), although heterogeneity was found (p = 0.04).
Conclusion:
MDC was significantly reduced hospital days and mortality rate in patients with CKD. The effective care model should be used to implantation in clinical settings.

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