Moriates Christopher, Mourad Michelle, Novelero Maria, Wachter Robert M
Division of Hospital Medicine, University of California, San Francisco, San Francisco, California.
J Hosp Med. 2014 Oct;9(10):671-7. doi: 10.1002/jhm.2235. Epub 2014 Jul 1.
Frontline physicians face increasing pressure to improve the quality of care they deliver while simultaneously decreasing healthcare costs. Although hospitals and physicians are beginning to implement initiatives targeting this new goal of healthcare value, few of them have a well-developed infrastructure to support this work.
In March 2012, we launched a high-value care (HVC) program within the Division of Hospital Medicine at the University of California, San Francisco. The HVC program is co-led by a physician and the division's administrator, and includes other hospitalists, resident physicians, pharmacists, and administrators. The program aims to (1) use financial and clinical data to identify areas with clear evidence of waste in the hospital, (2) promote evidence-based interventions that improve both quality of care and value, and (3) pair interventions with evidence-based cost awareness education to drive culture change.
We identified 6 ongoing projects during our first year. Preliminary data for our inaugural projects are encouraging. One initiative, which targeted decreasing nebulizer use on a high-acuity medical floor (often using metered-dose inhalers instead) led to a decrease in rates of more than 50%.
The HVC program is proving to be a successful mechanism to promote improved healthcare value and clinician engagement.
一线医生面临着越来越大的压力，既要提高他们提供的医疗服务质量，又要同时降低医疗成本。尽管医院和医生开始实施针对这一医疗价值新目标的举措，但其中很少有完善的基础设施来支持这项工作。
2012年3月，我们在加利福尼亚大学旧金山分校医院医学部内启动了一项高价值医疗（HVC）计划。该HVC计划由一名医生和该部门的管理人员共同领导，成员包括其他住院医师、实习医生、药剂师和管理人员。该计划旨在：（1）利用财务和临床数据识别医院中存在明显浪费证据的领域；（2）推广基于证据的干预措施，以提高医疗质量和价值；（3）将干预措施与基于证据的成本意识教育相结合，以推动文化变革。
在我们的第一年，我们确定了6个正在进行的项目。我们首个项目的初步数据令人鼓舞。一项旨在减少高 acuity 医疗楼层雾化器使用（通常改用定量吸入器）的举措使使用率下降了50%以上。
HVC计划被证明是促进提高医疗价值和临床医生参与度的成功机制。
