Speir Alan M, Rich Jeffrey B, Crosby Ivan, Fonner Edwin
Virginia Cardiac Surgery Quality Initiative, Falls Church, Virginia, USA.
Semin Thorac Cardiovasc Surg. 2009 Spring;21(1):12-9. doi: 10.1053/j.semtcvs.2009.03.005.
An era of increasing budgetary constraints, misaligned payers and providers, and a competitive system where United States health outcomes are outpaced by less well-funded nations is motivating policy-makers to seek more effective means for promoting cost-effective delivery and accountability. This article illustrates an effective working model of regional collaboration focused on improving health outcomes, containing costs, and making efficient use of resources in cardiovascular surgical care. The Virginia Cardiac Surgery Quality Initiative is a decade-old collaboration of cardiac surgeons and hospital providers in Virginia working to improve outcomes and contain costs by analyzing comparative data, identifying top performers, and replicating best clinical practices on a statewide basis. The group's goals and objectives, along with 2 generations of performance improvement initiatives, are examined. These involve attempts to improve postoperative outcomes and use of tools for decision support and modeling. This work has led the group to espouse a more integrated approach to performance improvement and to formulate principles of a quality-focused payment system. This is one in which collaboration promotes regional accountability to deliver quality care on a cost-effective basis. The Virginia Cardiac Surgery Quality Initiative has attempted to test a global pricing model and has implemented a pay-for-performance program where physicians and hospitals are aligned with common objectives. Although this collaborative approach is a work in progress, authors point out preconditions applicable to other regions and medical specialties. A road map of short-term next steps is needed to create an adaptive payment system tied to the national agenda for reforming the delivery system.
预算限制日益增加、支付方与医疗服务提供者目标不一致，以及美国在健康成果方面落后于资金投入较少国家的竞争体系，促使政策制定者寻求更有效的方法来促进具有成本效益的医疗服务提供和问责制。本文阐述了一个区域合作的有效工作模式，该模式专注于改善心血管外科护理的健康成果、控制成本以及有效利用资源。弗吉尼亚心脏手术质量倡议是弗吉尼亚州心脏外科医生和医院提供者之间长达十年的合作，旨在通过分析比较数据、找出表现最佳者并在全州范围内推广最佳临床实践来改善治疗效果并控制成本。本文审视了该组织的目标以及两代绩效改进举措。这些举措包括改善术后结果以及使用决策支持和建模工具。这项工作促使该组织支持一种更综合的绩效改进方法，并制定以质量为重点的支付系统原则。在这种支付系统中，合作促进区域问责，以具有成本效益的方式提供优质护理。弗吉尼亚心脏手术质量倡议尝试测试一种全球定价模式，并实施了一项按绩效付费计划，使医生和医院目标一致。尽管这种合作方式仍在不断完善之中，但作者指出了适用于其他地区和医学专业的前提条件。需要一份短期后续步骤路线图，以创建一个与国家医疗服务提供体系改革议程相关联的适应性支付系统。
