在全民医疗保健背景下建立区域性儿科外科服务：展望未来。

Lee Steven L, Sydorak Roman M, Marcus Donald H, Applebaum Harry

Division of Pediatric Surgery, Department of General Surgery, Kaiser Permanente, Los Angeles Medical Center, CA 90027, USA.

J Pediatr Surg. 2009 Jan;44(1):160-3. doi: 10.1016/j.jpedsurg.2008.10.027.

PURPOSE

Increasing health care expense and rising numbers of uninsured Americans have led many to propose a national health insurance. This study describes the process, rationale, and requirements in creating a regional pediatric surgical service in the setting of a single-payer system.

METHODS

Our health care system consists of 10 medical centers providing comprehensive care to more than 3 million members. All services are provided by salaried physicians/practitioners to prepaid members. Before July 2004, pediatric surgical care was performed at multiple medical centers with many services contracted out. Starting July 2004, a multidisciplinary, comprehensive pediatric perioperative plan was established. Implementation has occurred in steps; current status and preliminary results are reviewed.

RESULTS

Strict guidelines for pediatric anesthesia and requirements for support services, personnel, and equipment were defined. Pediatric surgery is now performed at 3 community medical centers and 1 tertiary, teaching hospital. Operative cases were assigned to each center based on age, complexity, level of postoperative care, and location. A single high-volume, center for complex care has been established. Access to care was excellent; more than 90% of outpatient consultations were seen within 2 weeks. Utilization of services was 94% in 2006 and 98% in 2007. Physician and patient satisfaction were high. Additional pediatric surgeons have been hired and nearly all care has been internalized. Given the proximity to a major children's hospital, specialty services have not been duplicated.

CONCLUSION

Establishing a multidisciplinary, comprehensive pediatric perioperative plan provided standards for supporting pediatric surgical services at community hospitals. This regional service may be a model for the future of specialty care, especially in the setting of a single-payer system.

目的

医疗保健费用的增加以及未参保美国人数的上升促使许多人提议实行国家医疗保险。本研究描述了在单一支付者体系下创建区域性小儿外科服务的过程、基本原理和要求。

方法

我们的医疗保健系统由10个医疗中心组成，为300多万会员提供全面护理。所有服务均由受薪医生/从业者提供给预付费会员。2004年7月之前，小儿外科护理在多个医疗中心进行，许多服务外包。从2004年7月开始，制定了多学科、全面的小儿围手术期计划。实施分阶段进行；对当前状况和初步结果进行了评估。

结果

确定了小儿麻醉的严格指南以及对支持服务、人员和设备的要求。小儿外科手术现于3个社区医疗中心和1家三级教学医院进行。根据年龄、复杂性、术后护理水平和地点将手术病例分配到每个中心。已设立了一个处理复杂病例的高容量单一中心。就医便利性极佳；超过90%的门诊会诊在2周内完成。2006年服务利用率为94%，2007年为98%。医生和患者满意度较高。已聘请了更多小儿外科医生，几乎所有护理都已实现内部化。鉴于靠近一家大型儿童医院，未重复设置专科服务。