Mark McClellan (
Krishna Udayakumar is executive director of Innovations in Healthcare, Duke University, director of the Duke Global Health Innovation Center, and an associate professor of global health and medicine at Duke University in Durham.
Health Aff (Millwood). 2017 Nov;36(11):1920-1927. doi: 10.1377/hlthaff.2017.0535.
Policy makers and providers are under increasing pressure to find innovative approaches to achieving better health outcomes as efficiently as possible. Accountable care, which holds providers accountable for results rather than specific services, is emerging in many countries to support such care innovations. However, these reforms are challenging and complex to implement, requiring significant policy and delivery changes. Despite global interest, the evidence on how to implement accountable care successfully remains limited. To improve the evidence base and increase the likelihood of success, we applied a comprehensive framework for assessing accountable care implementation to three promising reforms outside the United States. The framework relates accountable care policy reforms to the competencies of health care organizations and their health policy environments to facilitate qualitative comparisons of innovations and factors that influence success. We present emerging lessons to guide future implementation and evaluation of accountable care reforms to improve access to and the quality and affordability of care.
政策制定者和提供者面临越来越大的压力，需要寻找创新方法，以尽可能高效地实现更好的健康结果。问责制护理在许多国家兴起，旨在支持此类护理创新，这种模式要求提供者对结果而不是特定服务负责。然而，这些改革实施起来具有挑战性且复杂，需要进行重大的政策和交付变革。尽管全球对此类改革表现出浓厚的兴趣，但关于如何成功实施问责制护理的证据仍然有限。为了改善证据基础并增加成功的可能性，我们将一个全面的评估问责制护理实施情况的框架应用于美国以外的三个有前景的改革。该框架将问责制护理政策改革与医疗保健组织的能力及其卫生政策环境联系起来，以促进对创新和影响成功因素的定性比较。我们提出了一些新的经验教训，以指导未来问责制护理改革的实施和评估，从而改善医疗服务的可及性、质量和可负担性。
