Lee D, Nugent G
University of Washington School of Medicine.
Acad Med. 1989 Oct;64(10 Suppl):S44-50. doi: 10.1097/00001888-198910000-00025.
The adoption of an ambulatory care classification system by the Health Care Financing Administration in 1991 may have significant implications for medical education programs in the Department of Veterans Affairs (VA) ambulatory care setting. Presently there is not adequate methodology in the VA to determine costs in ambulatory care and education. (Experience with the VA allocation model suggests that selected characteristics of reimbursement systems are incompatible with educational goals.) Barriers that inhibit the cost-effective delivery of ambulatory care in many VA hospitals must be eliminated so that effective patient care and training care can take place. These barriers include inadequacies of information systems, physical layouts, and staffing. Despite the perception that outpatient care is less costly than inpatient care, the transition from an inpatient-based education model to an ambulatory care model will require an infusion of resources to improve the ambulatory care environment in the VA.
1991年医疗保健财务管理局采用门诊护理分类系统，可能会对退伍军人事务部（VA）门诊护理环境中的医学教育项目产生重大影响。目前，VA部门没有足够的方法来确定门诊护理和教育的成本。（VA分配模型的经验表明，报销系统的某些特征与教育目标不相容。）必须消除许多VA医院中阻碍以具有成本效益的方式提供门诊护理的障碍，以便能够提供有效的患者护理和培训护理。这些障碍包括信息系统、物理布局和人员配备不足。尽管人们认为门诊护理的成本低于住院护理，但从基于住院的教育模式向门诊护理模式的转变将需要注入资源，以改善VA的门诊护理环境。
