Teisberg Elizabeth O, Wallace Scott
Darden Graduate School of Business, University of Virginia, Charlottesville, Virginia 22903, USA.
Semin Thorac Cardiovasc Surg. 2009 Spring;21(1):35-42. doi: 10.1053/j.semtcvs.2009.03.003.
Health care reform that focuses on improving value enhances both the well-being of patients and the professional satisfaction of physicians. Value in health care is the improvement in health outcomes achieved for patients relative to the money spent. Dramatic and ongoing improvement in the value of health care delivered will require fundamental restructuring of the system. Current efforts to improve safety and reduce waste are truly important but not sufficient. The following three structural changes will drive simultaneous improvement in outcomes and efficiency: (1) reorganizing care delivery into clinically integrated teams defined by patient needs over the full cycle of care; (2) measuring and reporting patient outcomes by clinical teams, across the cycle of care and for identified clusters of medical circumstances; and (3) enabling reimbursement tied to value rather than to quantity of services. Many of these changes require physician leadership. We discuss steps on the journey to value-based care delivery.
聚焦于提升价值的医疗保健改革既能增进患者的福祉，又能提高医生的职业满意度。医疗保健中的价值是指相对于所花费的金钱，患者健康状况的改善。要实现所提供医疗保健价值的显著且持续的提升，需要对体系进行根本性的重组。当前为提高安全性和减少浪费所做的努力固然重要，但还不够。以下三项结构性变革将推动在医疗结果和效率方面同时取得改善：（1）将护理交付重新组织为由临床综合团队负责，这些团队根据患者在整个护理周期的需求来界定；（2）由临床团队在整个护理周期内并针对特定的医疗情况群组来衡量和报告患者结果；（3）使报销与价值而非服务数量挂钩。这些变革中的许多都需要医生发挥领导作用。我们讨论了迈向基于价值的护理交付的步骤。
