Lansky David, Milstein Arnold
Pacific Business Group on Health (PBGH), San Francisco, CA 94105, USA.
Clin Orthop Relat Res. 2009 Oct;467(10):2548-55. doi: 10.1007/s11999-009-0999-z. Epub 2009 Jul 30.
While all of medicine is under pressure to increase transparency and accountability, joint replacement subspecialists will face special scrutiny. Disclosures of questionable consulting fees, a demographic shift to younger patients, and uncertainty about the marginal benefits of product innovation in a time of great cost pressure invite a serious and progressive response from the profession. Current efforts to standardize measures by the National Quality Forum and PQRI will not address the concerns of purchasers, payors, or policy makers. Instead, they will ask the profession to document its commitment to appropriateness, stewardship of resources, coordination of care, and patient-centeredness. One mechanism for addressing these expectations is voluntary development of a uniform national registry for joint replacements that includes capture of preoperative appropriateness indicators, device monitoring information, revision rates, and structured postoperative patient followup. A national registry should support performance feedback and quality improvement activity, but it must also be designed to satisfy payor, purchaser, policymaker, and patient needs for information. Professional societies in orthopaedics should lead a collaborative process to develop metrics, infrastructure, and reporting formats that support continuous improvement and public accountability.
虽然整个医学领域都面临着提高透明度和问责制的压力，但关节置换专科医生将面临特别审查。可疑咨询费的披露、患者群体向年轻患者的转变，以及在成本压力巨大时期产品创新的边际效益的不确定性，都促使该行业做出严肃且渐进的回应。美国国家质量论坛（National Quality Forum）和医师质量报告倡议（PQRI）目前为规范措施所做的努力无法解决采购方、付款方或政策制定者的担忧。相反，他们将要求该行业证明其在适宜性、资源管理、护理协调和以患者为中心方面的承诺。实现这些期望的一种机制是自愿建立一个统一的全国关节置换登记系统，该系统应包括术前适宜性指标、器械监测信息、翻修率以及结构化的术后患者随访信息。全国登记系统应支持绩效反馈和质量改进活动，但它的设计还必须满足付款方、采购方、政策制定者和患者对信息的需求。骨科专业协会应引领一个协作过程，以制定支持持续改进和公共问责的指标、基础设施及报告格式。
