Sabin J E
Teaching Center, Harvard Community Health Plan, Boston, MA 02215.
Hosp Community Psychiatry. 1991 Jun;42(6):605-8. doi: 10.1176/ps.42.6.605.
Clinical practice in health maintenance organizations (HMOs) currently has many of the features that will become increasingly common in the managed-care environment in which mental health treatment will be provided in the 1990s. HMO policies calling for cost containment, attention to outcomes, practice audits, and treatment guidelines create distinctive demands on clinicians regarding their focus of attention, clinical stance, and professional role. The author identifies six crucial skills that can help clinicians meet these demands effectively: population-oriented practice management, population-oriented program development, ability to apply an adult developmental model, command of a broad repertoire of methodologies, ethical analysis, and advocacy. He uses brief case examples to illustrate how these skills may be used in managed-care settings.
健康维护组织（HMOs）中的临床实践目前具有许多将在20世纪90年代提供心理健康治疗的管理式医疗环境中变得越来越普遍的特征。HMO要求控制成本、关注结果、进行实践审核和制定治疗指南的政策，对临床医生在注意力焦点、临床立场和专业角色方面提出了独特的要求。作者确定了六项关键技能，可帮助临床医生有效满足这些要求：以人群为导向的实践管理、以人群为导向的项目开发、应用成人发展模型的能力、掌握广泛的方法、伦理分析和宣传。他使用简短的案例来说明这些技能在管理式医疗环境中如何应用。
