Training and Research Support Centre, United Kingdom; email:
Annu Rev Public Health. 2017 Mar 20;38:413-429. doi: 10.1146/annurev-publhealth-031816-044518.
Many high- and middle-income countries (HMICs) are experiencing a burden of comorbidity and chronic diseases. Together with increasing patient expectations, this burden is raising demand for population health-oriented innovation in health care. Using desk review and country case studies, we examine strategies applied in HMICs outside the United States to address these challenges, with a focus on and use of a new framework for analyzing primary care (PC). The article outlines how a population health approach has been supported by focusing assessment on and clustering services around social groups and multimorbidity, with support for community roles. It presents ways in which early first contact and continuity of PC, PC coordination of referral, multidisciplinary team approaches, investment in PC competencies, and specific payment and incentive models have all supported comprehensive approaches. These experiences locate PC as a site of innovation, where information technology and peer-to-peer learning networks support learning from practice.
许多高收入和中等收入国家（HMICs）正在承受共病和慢性病的负担。加上患者期望的不断提高，这种负担正在增加对面向人群健康的医疗保健创新的需求。我们使用案头审查和国家案例研究，研究了美国以外的 HMICs 应用的应对这些挑战的策略，重点是并使用了一个新的分析初级保健（PC）的框架。本文概述了如何通过关注和围绕社会群体和多种疾病对服务进行聚类来支持以人群为基础的方法，以及对社区角色的支持，从而支持人口健康方法。它介绍了早期首次接触和 PC 的连续性、PC 转诊协调、多学科团队方法、对 PC 能力的投资以及特定的支付和激励模式如何共同支持全面方法。这些经验将 PC 定位为创新的场所，信息技术和同行学习网络支持从实践中学习。
