Schumacher Group, Lafayette, LA, USA.
Acad Emerg Med. 2010 Dec;17(12):1330-6. doi: 10.1111/j.1553-2712.2010.00934.x.
In 2006, the Institute of Medicine (IOM) advanced the concept of "coordinated, regionalized, and accountable emergency care systems" to address significant problems with the delivery of emergency medical care in the United States. Achieving this vision requires the thoughtful implementation of well-aligned, system-level structures and processes that enhance access to emergency care and improve patient outcomes at a sustainable cost. Currently, the delivery of emergency medical care is supported by numerous administrative systems, including economic; reimbursement; legal and regulatory structures; licensure, credentialing, and accreditation processes; medicolegal systems; and quality reporting mechanisms. In addition, many regionalized systems may not optimize patient outcomes because of current administrative barriers that make it difficult for providers to deliver the best care. However, certain administrative barriers may also threaten the sustainability of integration efforts or prevent them altogether. This article identifies significant administrative challenges to integrating networks of emergency care in four specific areas: reimbursement, medical-legal, quality reporting mechanisms, and regulatory aspects. The authors propose a research agenda for indentifying optimal approaches that support consistent access to quality emergency care with improved outcomes for patients, at a sustainable cost. Researching administrative challenges will involve careful examination of the numerous natural experiments in the recent past and will be crucial to understand the impact as we embark on a new era of health reform.
2006 年,美国医学研究所 (IOM) 提出了“协调、区域化和负责任的紧急护理系统”的概念,以解决美国提供紧急医疗护理方面存在的重大问题。实现这一愿景需要深思熟虑地实施协调一致的系统级结构和流程,以提高获得紧急护理的机会,并以可持续的成本改善患者的治疗效果。目前,紧急医疗护理的提供由众多管理系统支持,包括经济系统、报销系统、法律和监管结构、许可、认证和认可流程、法医学系统和质量报告机制。此外,由于当前的管理障碍使得提供者难以提供最佳护理,许多区域化系统可能无法优化患者的治疗效果。然而,某些管理障碍也可能威胁到整合工作的可持续性,或者完全阻止整合工作的进行。本文确定了在四个具体领域整合紧急护理网络所面临的重大管理挑战:报销、医疗法律、质量报告机制和监管方面。作者提出了一个研究议程,以确定支持患者治疗效果改善和可持续成本下获得一致的高质量紧急护理的最佳方法。研究管理挑战需要仔细研究过去的众多自然实验,并将有助于了解我们在新的卫生改革时代所面临的影响。