Wei David H, Hawker Gillian A, Jevsevar David S, Bozic Kevin J
Department of Orthopaedics, Tufts University Medical Center, 800 Washington Street, TMC Box #306, Boston, MA 02111. E-mail address:
Women's College Research Institute, Women's College Hospital, University of Toronto, 190 Elizabeth Street, Suite RFE 3-805, Toronto, ON M5G 2C4, Canada. E-mail address:
J Bone Joint Surg Am. 2015 May 6;97(9):769-74. doi: 10.2106/JBJS.N.00841.
Improving value in musculoskeletal health care has emerged as an important objective in both the United States and Canada. In order to achieve this objective, providers need to have a clear definition of value and an infrastructure for measuring outcomes of interest to patients and costs over the episode of care. Although national patient registries have been established in the United States and Canada, they nevertheless lag behind other registries worldwide in terms of collecting patient-reported outcomes and capturing data from a wide cross-section of hospitals and physicians. With the help of professional medical societies and the creation of national initiatives, patient-reported outcomes data collection on a large scale may be possible, but many challenges remain regarding implementation. Alternatives to the fee-for-service payment model, including pay-for-reporting and pay-for-performance, may help incentivize physicians and health-care providers to obtain and improve on patient-reported outcomes data collection. Other payment reforms, such as bundled payments, have been piloted in certain regions, but their sustainability and long-term success are unclear at this time. Novel health-care delivery strategies aimed at improving quality, coordinating multispecialty care, and enhancing patient participation in shared decision-making have shown promise in improving patient-centered outcomes, but delivery models continue to vary greatly throughout the United States and Canada. The current status of musculoskeletal health-care delivery requires substantial change before the goal of improving patient outcomes and lowering health-care costs can be achieved.
提高肌肉骨骼医疗保健的价值已成为美国和加拿大的一项重要目标。为实现这一目标，医疗服务提供者需要对价值有清晰的定义，并建立一个用于衡量患者关注的结果以及整个护理过程中成本的基础设施。尽管美国和加拿大已经建立了国家患者登记系统，但在收集患者报告的结果以及从广泛的医院和医生群体中获取数据方面，它们仍落后于世界其他登记系统。借助专业医学协会并开展国家倡议，大规模收集患者报告的结果数据或许可行，但在实施方面仍存在诸多挑战。替代按服务收费支付模式的方式，包括按报告付费和按绩效付费，可能有助于激励医生和医疗服务提供者获取并改进患者报告的结果数据收集。其他支付改革，如捆绑支付，已在某些地区进行试点，但目前其可持续性和长期成效尚不明朗。旨在提高质量、协调多专科护理以及增强患者参与共同决策的新型医疗保健提供策略，在改善以患者为中心的结果方面已展现出前景，但美国和加拿大各地的提供模式仍存在很大差异。在实现改善患者结果和降低医疗保健成本的目标之前，肌肉骨骼医疗保健提供的现状需要进行重大变革。
