MacColl Institute for Healthcare Innovation, Group Health Research Institute, Seattle, WA 98101, USA.
J Gen Intern Med. 2010 Sep;25 Suppl 4(Suppl 4):S636-8. doi: 10.1007/s11606-010-1442-6.
Most proposals to reform health care delivery center on a robust, well-designed primary care sector capable of reducing the health and cost consequences of major chronic illnesses. Ironically, the intensified policy interest in primary care coincides with a steep decline in the proportion of medical students choosing primary care careers. Negativity stemming from the experience of trying to care for chronically ill patients with complex conditions in poorly designed, chaotic primary care teaching settings may be influencing trainees to choose other career paths. Redesigning teaching clinics so that they routinely provide high quality, well-organized chronic care would appear to be a critical early step in addressing the looming primary care workforce crisis. The Chronic Care Model provides a proven framework for such a redesign, and has been, with organizational support and effort, successfully implemented in academic settings.
大多数医疗服务改革方案都侧重于建立一个强大、精心设计的初级保健部门，以减少主要慢性病对健康和成本的影响。具有讽刺意味的是，人们对初级保健的政策兴趣日益浓厚，而选择从事初级保健职业的医学生比例却大幅下降。在设计不佳、混乱的初级保健教学环境中，试图为患有复杂慢性病的患者提供护理所带来的负面影响，可能会影响受训者选择其他职业道路。对教学诊所进行重新设计，使其常规提供高质量、组织良好的慢性病护理，这似乎是解决即将到来的初级保健劳动力危机的关键的第一步。慢性病护理模式为这种重新设计提供了一个经过验证的框架，并且已经在学术环境中得到了组织支持和努力，成功实施。
