Greysen S Ryan, Detsky Allan S
Division of Hospital Medicine, University of California San Francisco, San Francisco, California.
Institute of Health Policy, Management and Evaluation and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Hosp Med. 2015 Oct;10(10):697-700. doi: 10.1002/jhm.2421. Epub 2015 Aug 19.
Improving transitions of care from the acute care setting has been an important focus of health policy in the United States and Canada. Over the past decade, hospital performance metrics related to successful recovery have been used in the United States to implement incentives for reform. This focus has led to a laudable number of interventions to reduce readmissions--a proxy for failed recovery--but most of these have focused on the hospital or system level rather than the individual physician level. Individual physicians in both the inpatient and outpatient setting have important roles to play, but little guidance or structured support is available to them to enable successful engagement in postdischarge management of patient transitions. We describe several tensions of physician engagement in this process from the perspective of front-line providers and highlight several possible approaches to improve physician engagement in transitions.
改善急性护理环境下的医疗过渡一直是美国和加拿大卫生政策的重要关注点。在过去十年中，美国已将与成功康复相关的医院绩效指标用于实施改革激励措施。这种关注带来了大量值得称赞的干预措施以减少再入院率（衡量康复失败的一个指标），但其中大多数措施都集中在医院或系统层面，而非个体医生层面。住院和门诊环境中的个体医生都能发挥重要作用，但他们在参与患者出院后过渡管理方面几乎得不到指导或结构化支持。我们从一线医疗服务提供者的角度描述了医生参与这一过程时面临的几种矛盾，并强调了几种提高医生参与过渡过程的可能方法。
