Starfield B
Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205.
HMO Pract. 1993 Sep;7(3):103-9.
The contributions of HMOs to research and education are important in the generation of knowledge for policy development and for training physicians to meet the needs of populations. While prepaid group practices that were the prototypical HMOs added important new information about the organization and delivery of health services, the new generation of managed care organizations has not been involved in either research or teaching. Issues that are particularly amenable to research in HMOs include the appropriate balance between primary care providers and specialists, criteria for referral from primary care to specialty services, the contributions of preventive care to health, and the testing of alternative strategies to achieve the four important characteristics of primary care practice. HMOs could also make important contributions to medical education by exposing students and residents to quality of care assessments and to practice-based research, as well as to the special challenges and rewards of population-based medical care.
健康维护组织（HMOs）对研究和教育的贡献，对于政策制定知识的生成以及培养能满足民众需求的医生而言至关重要。虽然作为典型HMOs的预付团体医疗模式增添了有关健康服务组织与提供方面的重要新信息，但新一代的管理式医疗组织却未涉足研究或教学领域。在HMOs中特别适合开展研究的问题包括：初级保健提供者与专科医生之间的适当平衡、从初级保健转诊至专科服务的标准、预防性保健对健康的贡献，以及对实现初级保健实践四个重要特征的替代策略的测试。HMOs还可通过让学生和住院医师接触医疗质量评估、基于实践的研究，以及基于人群的医疗保健所面临的特殊挑战与回报，从而对医学教育做出重要贡献。
