Hoff Timothy J, Soerensen Christina
School of Public Health, University at Albany, Rensselaer, New York 12144, USA.
Qual Manag Health Care. 2011 Jan-Mar;20(1):62-75. doi: 10.1097/QMH.0b013e31820311d2.
In 2008, the Centers for Medicare & Medicaid Services (CMS) implemented a policy of not paying hospitals for the care of several preventable hospital-acquired conditions. The CMS policy is a unique value-based purchasing initiative because it relies on penalties rather than on rewards. Because of its novelty, less is known in advance about how this type of payment approach might work, get implemented, or be viewed by stakeholders in health care. As a result, the early published literature focusing on the CMS policy may serve as an important frame of reference among managers, policy makers, and researchers for guiding attitudes and behaviors. This review examines over an initial 3-year period academic and trade articles addressing the CMS policy to gain the impressions, guidance, and content provided in this literature. Key findings include an inordinately small number of articles focused on the new CMS policy; little original research or empirical prediction on CMS policy implementation and outcomes; a highly opinionated, non-evidence-based literature; a literature less able to address the policy impact for specific preventable complications or hospital settings; and a high percentage of articles making inconsistent, broad-based linkages between the CMS policy and specific quality improvement initiatives that potentially limit the policy's long-term acceptance as an improvement strategy.
2008年，美国医疗保险和医疗补助服务中心（CMS）实施了一项政策，即对于几种可预防的医院获得性疾病的治疗，不再向医院支付费用。CMS的这项政策是一项独特的基于价值的采购举措，因为它依靠的是惩罚而非奖励。由于其新颖性，人们事先对这种支付方式如何运作、如何实施或医疗保健领域的利益相关者会如何看待了解较少。因此，早期发表的关注CMS政策的文献，可能会成为管理者、政策制定者和研究人员指导态度和行为的重要参考框架。本综述在最初的三年时间里，对论述CMS政策的学术文章和行业文章进行了研究，以了解该文献中提供的观点、指导和内容。主要发现包括：关注CMS新政策的文章数量极少；对CMS政策实施和结果的原创研究或实证预测很少；文献中观点性很强，缺乏证据支持；该文献较难阐述该政策对特定可预防并发症或医院环境的影响；以及很大比例的文章在CMS政策与特定质量改进举措之间建立了不一致的、宽泛的联系，这可能会限制该政策作为一种改进策略被长期接受。
