Miller L G
Health Payment Review, Boston, MA, USA.
Physician Exec. 1995 Oct;21(10):40-1.
Judging by the interest expressed by managed care organizations, provider profiling has arrived. Surveys indicate that most organizations have adopted, or plan to adopt in the near future, a means to describe provider practice patterns. A further vote of confidence came from providers: In 1994, the American College of Physicians, the largest national specialty organization, issued a position paper supporting provider profiling and questioning the value of other approaches to utilization management, such as preauthorization of individual services. Also, an article and an editorial in the New England Journal of Medicine cautiously supported the concept of profiling. Provider profiling has great promise as a means to promote cost-effective care without the limitations of case-by-case preauthorization. The combination of a sophisticated episode of care methodology and a set of validated practice benchmarks offers the opportunity to perform true clinical profiling and to supply providers with data to review and alter practice patterns.
从管理式医疗组织所表现出的兴趣来看，医疗服务提供者概况分析已经到来。调查表明，大多数组织已经采用，或者计划在不久的将来采用一种描述医疗服务提供者执业模式的方法。医疗服务提供者也进一步表达了信心：1994年，最大的全国性专业组织美国医师学院发表了一篇立场文件，支持医疗服务提供者概况分析，并质疑其他利用管理方法的价值，比如对个别服务进行预先授权。此外，《新英格兰医学杂志》上的一篇文章和一篇社论也谨慎地支持了概况分析的概念。作为一种促进具有成本效益的医疗服务且不受逐案预先授权限制的手段，医疗服务提供者概况分析前景广阔。复杂的医疗事件方法与一套经过验证的执业基准相结合，为进行真正的临床概况分析以及向医疗服务提供者提供数据以审查和改变执业模式提供了机会。
