Medford-Davis Laura, Marcozzi David, Agrawal Shantanu, Carr Brendan G, Carrier Emily
Baylor College of Medicine, Houston, TX; Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation, Baltimore, MD.
Department of Emergency Medicine, University of Maryland, Baltimore, MD.
Ann Emerg Med. 2017 Jun;69(6):675-683. doi: 10.1016/j.annemergmed.2016.10.031. Epub 2017 Jan 5.
Although emergency departments (EDs) play an integral role in the delivery of acute unscheduled care, they have not been fully integrated into broader health care reform efforts. Communication and coordination with the ambulatory environment remain limited, leaving ED care disconnected from patients' longitudinal care. In a value-based environment focused on improving quality, decreasing costs, enhancing population health, and improving the patient experience, this oversight represents a missed opportunity for emergency care. When integrated with primary and subspecialty care, emergency care might meet the needs of patients, providers, and payers more efficiently than yet realized. This article uses the Merit-Based Incentive Payment System from the Medicare Access and CHIP Reauthorization Act as a framework to outline a strategy for improving the value of emergency care, including integrating quality and resource use measures across health care delivery settings and populations, encouraging care coordination from the ED, and implementing robust health information exchange systems.
尽管急诊科在提供急性非预约护理方面发挥着不可或缺的作用，但它们尚未完全融入更广泛的医疗改革努力之中。与门诊环境的沟通与协调仍然有限，导致急诊护理与患者的长期护理脱节。在一个注重提高质量、降低成本、增进人群健康和改善患者体验的基于价值的环境中，这种疏忽意味着急诊护理错失了一个机会。当与初级和专科护理相结合时，急诊护理可能比目前所认识到的更有效地满足患者、提供者和支付方的需求。本文以《医疗保险准入与儿童健康保险计划再授权法案》中的基于绩效的激励支付系统为框架，概述了一项提高急诊护理价值的策略，包括整合跨医疗服务提供环境和人群的质量与资源使用措施、鼓励急诊科进行护理协调，以及实施强大的健康信息交换系统。
