Margolis Ronald B, Pollard C Alec, Niemiec Ryan
Department of Family and Community Medicine.
Fam Syst Health. 2013 Sep;31(3):239-47. doi: 10.1037/a0032307.
The primary care literature provides some useful information and several project examples for clinicians attempting to develop an integrated care practice, but prior discussion has been based largely on projects developed in government-funded or HMO systems. The current paper focuses on the business challenges of establishing an integrated care practice in a private, fee-for-service setting. Despite increasing commitment to the concept of the medical home, which embraces behavioral health care, physicians in the private sector remain cautious about proposed practice changes such as integrated care. There are additional obstacles that can impede successful implementation of integrated primary care in the private sector. The authors identify five major challenges and suggest potential strategies to address these challenges, drawing, in part, on their experience with a 4-year integrated primary care demonstration project.
基层医疗文献为试图开展综合医疗实践的临床医生提供了一些有用信息和几个项目实例，但此前的讨论主要基于在政府资助或健康维护组织（HMO）系统中开展的项目。本文聚焦于在私立的、按服务收费环境中建立综合医疗实践所面临的商业挑战。尽管对包含行为健康护理的医疗之家概念的承诺不断增加，但私营部门的医生对于诸如综合医疗等拟议的实践变革仍持谨慎态度。在私营部门，还有其他障碍可能阻碍综合基层医疗的成功实施。作者识别出五个主要挑战，并提出应对这些挑战的潜在策略，部分借鉴了他们在一个为期四年的综合基层医疗示范项目中的经验。
