McGlynn Elizabeth A, McClellan Mark
Elizabeth A. McGlynn (
Mark McClellan is director of the Duke-Robert J. Margolis, MD, Center for Health Policy and the Robert J. Margolis, MD, Professor of Business, Medicine, and Health Policy, both at Duke University, in Durham, North Carolina, and Washington, D.C.
Health Aff (Millwood). 2017 Mar 1;36(3):408-416. doi: 10.1377/hlthaff.2016.1373.
Driven by evidence of continuing gaps in health care quality and efficiency and inspired by the emergence of new value-based payment models, both large and small health care organizations are developing and deploying a wide range of care delivery innovations. But how can decision makers in these organizations determine if the innovations really improve service delivery, patient experience, clinical outcomes, or costs? Organization leaders need appropriate, timely evidence to inform their decision making. In this article we describe a range of approaches to evaluating innovations and pose key questions about the validity of the results. We highlight a specific type of evaluation approach-the stepped wedge design-because it can balance the need for internal and external validity with the ability to generate timely results. We elaborate on three key steps in the innovation assessment phase (identifying the target population, describing baseline performance, and documenting the components of the innovation) that are useful for both organizations that will generate new evidence and those using evidence generated by others. We conclude with a discussion of payer approaches for supporting health care organizations in their efforts to develop new evidence on innovations.
受医疗保健质量和效率持续存在差距的证据驱动，并受新的基于价值的支付模式出现的启发，大大小小的医疗保健组织都在开发和部署各种护理交付创新。但是，这些组织中的决策者如何确定这些创新是否真的改善了服务交付、患者体验、临床结果或成本呢？组织领导者需要适当、及时的证据来为他们的决策提供依据。在本文中，我们描述了一系列评估创新的方法，并对结果的有效性提出了关键问题。我们重点介绍了一种特定类型的评估方法——阶梯楔形设计，因为它可以在内部和外部有效性的需求与及时产生结果的能力之间取得平衡。我们详细阐述了创新评估阶段的三个关键步骤（确定目标人群、描述基线表现以及记录创新的组成部分），这对将生成新证据的组织以及使用他人生成的证据的组织都很有用。我们最后讨论了支付方支持医疗保健组织努力开发创新新证据的方法。
