探索门急诊和疾病管理中的卫生系统反应性及其与卫生系统绩效其他维度的关系（RAC）——研究设计与方法。
Exploring Health System Responsiveness in Ambulatory Care and Disease Management and its Relation to Other Dimensions of Health System Performance (RAC) - Study Design and Methodology.
机构信息
Department of Health Care Management, Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany.
Wissenschaftliches Institut der TK für Nutzen und Effizienz im Gesundheitswesen (WINEG), Hamburg, Germany.
出版信息
Int J Health Policy Manag. 2015 May 20;4(7):431-7. doi: 10.15171/ijhpm.2015.97.
BACKGROUND
The responsiveness of a health system is considered to be an intrinsic goal of health systems and an essential aspect in performance assessment. Numerous studies have analysed health system responsiveness and related concepts, especially across different countries and health systems. However, fewer studies have applied the concept for the evaluation of specific healthcare delivery structures and thoroughly analysed its determinants within one country. The aims of this study are to assess the level of perceived health system responsiveness to patients with chronic diseases in ambulatory care in Germany and to analyse the determinants of health system responsiveness as well as its distribution across different population groups.
METHODS AND ANALYSIS
The target population consists of chronically ill people in Germany, with a focus on patients suffering from type 2 diabetes and/or from coronary heart disease (CHD). Data comes from two different sources: (i) cross-sectional survey data from a postal survey and (ii) claims data from a German sickness fund. Data from both sources will be linked at an individual-level. The postal survey has the purpose of measuring perceived health system responsiveness, health related quality of life, experiences with disease management programmes (DMPs) and (subjective) socioeconomic background. The claims data consists of information on (co)morbidities, service utilization, enrolment within a DMP and sociodemographic characteristics, including the type of residential area.
DISCUSSION
RAC is one of the first projects linking survey data on health system responsiveness at individual level with claims data. With this unique database, it will be possible to comprehensively analyse determinants of health system responsiveness and its relation to other aspects of health system performance assessment. The results of the project will allow German health system decision-makers to assess the performance of nonclinical aspects of healthcare delivery and their determinants in two important areas of health policy: in ambulatory and chronic disease care.
背景
医疗体系的响应性被认为是医疗体系的内在目标，也是绩效评估的重要方面。许多研究已经分析了医疗体系的响应性和相关概念，特别是在不同国家和医疗体系之间。然而，较少的研究将该概念应用于评估特定医疗保健提供结构，并在一个国家内彻底分析其决定因素。本研究的目的是评估德国门诊慢性病患者对医疗体系响应性的感知水平，并分析医疗体系响应性的决定因素及其在不同人群中的分布。
方法和分析
目标人群包括德国的慢性病患者，重点是 2 型糖尿病和/或冠心病患者。数据来自两个不同的来源：（i）来自邮政调查的横断面调查数据，（ii）来自德国疾病基金的索赔数据。两个来源的数据将在个体层面上进行链接。邮政调查旨在测量感知医疗体系响应性、与健康相关的生活质量、疾病管理计划（DMP）的体验（主观）社会经济背景。索赔数据包括（共）患病情况、服务利用、DMP 注册和社会人口学特征信息，包括居住区域类型。
讨论
RAC 是第一个将个体层面的医疗体系响应性调查数据与索赔数据相链接的项目之一。通过这个独特的数据库，我们将能够全面分析医疗体系响应性的决定因素及其与医疗体系绩效评估其他方面的关系。该项目的结果将使德国卫生系统决策者能够评估两个重要卫生政策领域（门诊和慢性病护理）中非临床医疗保健提供方面及其决定因素的绩效。
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