Murray Alice Ca
London, NE Thames rotation General Surgery Registrar, Division of Colorectal Surgery, King George's Hospital, Ilford, Essex IG3 8YB.
Br J Hosp Med (Lond). 2018 Jun 2;79(6):316-321. doi: 10.12968/hmed.2018.79.6.316.
NHS trusts across the country are facing unprecedented financial pressures, along with rising levels of demand and widespread variation in surgical quality and cost. There is a moral and financial imperative to provide the most efficient use of resources in order to ensure sustainability of a system that is free at the point of use, and provide consistently high-value care for patients across the country. Delivering 'value' does not mean any reduction in the quality of care - it means achieving the same or higher quality at the same or lower cost. Avoidable and costly incidents in surgery occur every day: patients do not receive the right care, procedures or tests are performed without real benefit, complications lead to prolonged hospital stays, to readmissions and re-interventions. Put simply: poor quality surgical care is expensive. The concept of value-based health care is well known in the UK, yet its principles are not yet fully embedded in the health-care system, surgical training or practice. The shift towards better value-based care with a focus on delivery system reform (Getting It Right First Time), outcomes-based commissioning and payment reform (accountable care systems and integrated care systems) provides an opportunity to make significant improvements in surgical care. Radical and immediate change is required, and everyone, from trainees at the frontline, to clinical leaders, trust chief executives, local commissioners and policy-makers, has vital roles to play. The health-care system needs to be designed, organized and paid for differently to deliver better surgical value for patients.
英国各地的国民保健服务信托基金面临着前所未有的财政压力，同时需求不断增加，手术质量和成本存在广泛差异。为了确保在使用时免费的医疗体系的可持续性，并为全国患者提供始终如一的高价值护理，在道德和财政上都迫切需要最有效地利用资源。提供“价值”并不意味着降低护理质量——而是意味着以相同或更低的成本实现相同或更高的质量。手术中每天都会发生可避免且代价高昂的事件：患者没有得到正确的护理，进行的手术或检查没有实际益处，并发症导致住院时间延长、再次入院和再次干预。简单地说：质量差的手术护理成本高昂。基于价值的医疗保健概念在英国广为人知，但其原则尚未完全融入医疗保健系统、外科培训或实践中。向以交付系统改革（一次做对）、基于结果的委托和支付改革（问责制医疗系统和综合医疗系统）为重点的更好的基于价值的护理转变，为显著改善手术护理提供了机会。需要进行彻底和立即的变革，从一线实习生到临床领导者、信托基金首席执行官、地方委托方和政策制定者，每个人都要发挥至关重要的作用。医疗保健系统需要在设计、组织和支付方式上进行不同的调整，以便为患者提供更好的手术价值。
