Goldberg Harold I, Rund Douglas A, Hopkins Joseph R
Department of Medicine, University of Washington, Seattle, USA.
Med Care. 2002 Apr;40(4 Suppl):II32-9.
A Joint Planning Committee Report was issued in 1974 exploring how Stanford University might itself provide primary care to students, faculty, employees and their dependents at low cost. The report called for the creation of a health maintenance organization owned by its subscribers in affiliation with Stanford Medical Center. However, because the report was dismissed by the dean of the School of Medicine as being unworkable, the Midpeninsula Health Service (MHS) began operating as an unaffiliated, nonprofit health plan in downtown Palo Alto in January 1976. The MHS's planning, early operation, move to the Stanford campus, financial viability and ultimate fate are examined as an example of action research in health care.
Source documents were examined by the authors, a founding MHS board member and its two inaugural medical directors, in compiling a 30-year organizational history.
The MHS was remarkably prescient in its early use of small primary care groups that included midlevel practitioners, the principles of evidence-based medicine, the participation of patients in self-care activities, and a commitment to the continuous monitoring and improvement of quality. Imputed annualized costs of care were 30% lower than contemporary fee-for-service care and 20% lower than that of Kaiser, with no discernible difference in health outcomes.
Action research methods can be useful in identifying and testing potential solutions to vexing problems in health care delivery.
1974年发布了一份联合规划委员会报告，探讨斯坦福大学如何以低成本为学生、教职员工及其家属提供初级医疗服务。该报告呼吁成立一个由其订阅者拥有的健康维护组织，与斯坦福医疗中心建立附属关系。然而，由于医学院院长认为该报告不可行而将其驳回，中半岛健康服务中心（MHS）于1976年1月在帕洛阿尔托市中心开始作为一个独立的非营利性健康计划运营。作为医疗保健行动研究的一个例子，对MHS的规划、早期运营、迁至斯坦福大学校园、财务可行性和最终命运进行了研究。
作者（一位MHS创始董事会成员及其两位首任医疗主任）在编撰30年组织历史时查阅了原始文件。
MHS在早期使用包括中级从业者的小型初级医疗小组、循证医学原则、患者参与自我护理活动以及致力于持续监测和提高质量方面具有非凡的先见之明。推算的年度护理成本比当时的按服务收费护理低30%，比凯撒医疗集团低20%，健康结果没有明显差异。
行动研究方法有助于识别和测试解决医疗保健服务中棘手问题的潜在解决方案。
