VA Health Services Research and Development Center on Implementing Evidence-based Practice, Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA.
Med Care. 2011 Dec;49 Suppl:S59-64. doi: 10.1097/MLR.0b013e31821b57eb.
U.S. healthcare requires major redesign of its delivery systems, finances, and incentives. Healthcare operations, leadership, and payors are increasingly recognizing the need for community-business-research partnerships to transform healthcare. New models of continuous learning, research, and development should help focus and sustain redesign efforts.
This study summarizes suggested strategies for transformational change in healthcare and identifies needed areas for research to inform, spread, and sustain transformational change.
We developed these recommendations based on a series of review papers, invited expert discussion, and a subsequent review in the context of a health system transformation research conference (The Regenstrief Biennial Research Conference). The multidisciplinary audience included health systems researchers, clinicians, informaticians, social and engineering scientists, and operational and business leaders.
Conference participants and literature reviews identified key strategies for system redesign with the following themes: using the framework of complex adaptive systems; fostering organizational redesign; developing appropriate performance measures and incentives; creating continuous learning organizations; and integrating health information, technology, and communication into practice. Sustained investment in research and development in these areas is crucial.
Multiple issues influence the likelihood that healthcare leaders will make transformational changes in their healthcare systems. Healthcare leaders, clinicians, researchers, journals, and academic institutions, in partnership with payors, government and multiple other stakeholders, should apply the recommendations relevant to their own setting to redesign healthcare delivery, improve cognitive support, and sustain transformation. Fostering further research investments in these areas will increase the impact of transformation on the health and healthcare of the public.
美国医疗保健需要对其提供系统、财务和激励措施进行重大重新设计。医疗保健运营、领导层和支付方越来越认识到需要建立社区-企业-研究伙伴关系来改变医疗保健。新的持续学习、研究和开发模式应该有助于集中和维持重新设计的努力。
本研究总结了医疗保健变革的建议策略，并确定了需要研究的领域，以为变革提供信息、推广和维持。
我们根据一系列评论文章、特邀专家讨论以及在医疗系统转型研究会议（Regenstrief 双年研究会议）背景下的后续审查制定了这些建议。多学科受众包括卫生系统研究人员、临床医生、信息学家、社会和工程科学家以及运营和业务领导者。
会议参与者和文献综述确定了系统重新设计的关键策略，主题包括：使用复杂适应系统框架；促进组织重新设计；制定适当的绩效衡量标准和激励措施；创建持续学习组织；并将健康信息、技术和通信整合到实践中。在这些领域持续投资研究和开发至关重要。
多个问题影响医疗保健领导者对其医疗系统进行变革的可能性。医疗保健领导者、临床医生、研究人员、期刊和学术机构应与支付方、政府和其他多个利益相关者合作，将与自身环境相关的建议应用于重新设计医疗服务提供、改善认知支持并维持转型。在这些领域促进进一步的研究投资将提高变革对公众健康和医疗的影响。
