Department of Pediatrics and Doernbecher Neonatal Care Center, Oregon Health and Science University, Portland, Oregon; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;
Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
Pediatrics. 2016 Mar;137(3):e20150312. doi: 10.1542/peds.2015-0312. Epub 2016 Feb 10.
Rising health care costs challenge governments, payers, and providers in delivering health care services. Tremendous pressures result to deliver better quality care while simultaneously reducing costs. This has led to a wholesale re-examination of current practice methods, including explicit consideration of efficiency and waste. Traditionally, reductions in the costs of care have been considered as independent, and sometimes even antithetical, to the practice of high-quality, intensive medicine. However, it is evident that provision of evidence-based, locally relevant care can result in improved outcomes, lower resource utilization, and opportunities to reallocate resources. This is particularly relevant to the practice of neonatology. In the United States, 12% of the annual birth cohort is affected by preterm birth, and 3% is affected by congenital anomalies. Both of these conditions are associated with costly health care during, and often long after, the NICU admission. We will discuss how 3 drivers of clinical practice in neonatal care (evidence-based medicine, evidence-based economics, and quality improvement) can together optimize clinical and fiscal outcomes.
不断上涨的医疗保健成本给政府、支付方和医疗服务提供者带来了挑战。为了提供更好的医疗服务质量，同时降低成本，他们承受着巨大的压力。这导致人们对当前的实践方法进行了全面审查，包括对效率和浪费的明确考虑。传统上，降低医疗成本被认为是独立的，有时甚至是相反的，与高质量、强化医疗的实践。然而，提供基于证据、符合当地实际情况的医疗服务显然可以改善结果、降低资源利用，并为资源重新分配提供机会。这在新生儿学领域尤为相关。在美国，每年有 12%的出生队列受到早产的影响，有 3%的出生队列受到先天畸形的影响。这两种情况都与新生儿重症监护病房（NICU）入院期间和之后很长一段时间内昂贵的医疗保健费用有关。我们将讨论新生儿护理临床实践的 3 个驱动因素（循证医学、循证经济学和质量改进）如何共同优化临床和财务结果。
