Elder Charles, Ijaz Nadine, Weeks John, Rioux Jennifer, Ritenbaugh Cheryl
1 Kaiser Permanente Center for Health Research, Portland, OR.
2 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
J Altern Complement Med. 2019 Mar;25(S1):S12-S16. doi: 10.1089/acm.2018.0515.
Value-based health care has emerged as a manifestation of the conventional medicine community's awareness of the overlapping needs to both better incorporate patient centeredness into practice and research paradigms and further develop a systemic approach to cost reduction.
The origins of the whole systems research (WSR) movement date to the late 1990s, when the U.S. Congress legislated appropriation of funds to stimulate the U.S. National Institutes of Health to evaluate popular traditional, complementary, and integrative medicine (TCIM) practices. Questions immediately arose over how well these forms of practice could be measured through standard randomized controlled trials, and the WSR community began to articulate and adapt innovative methodologies for evaluating TCIM interventions.
This column explores the potential impact of WSR methods and exemplars on the clinical practice and research communities seeking to successfully implement and measure the complexities of value-based health care. Four potentially cross-talking themes are specifically discussed: complex behaviorally focused interventions, patient-centered outcomes, team-based care, and resilience and well-being.
The time is ripe for clinicians and investigators to capitalize on methodologies, exemplars, and learnings from the WSR literature toward improving care, developing more robust research strategies, and furthering the dialogue between the TCIM and conventional medicine communities.
基于价值的医疗保健已成为传统医学领域的一种表现形式，体现了人们意识到需要更好地将以患者为中心的理念融入实践和研究范式，以及进一步制定系统性的成本降低方法。
全系统研究（WSR）运动起源于20世纪90年代末，当时美国国会立法拨款，以刺激美国国立卫生研究院评估流行的传统、补充和整合医学（TCIM）实践。对于这些实践形式能否通过标准的随机对照试验进行有效衡量，立即出现了疑问，WSR社区开始阐明并采用创新方法来评估TCIM干预措施。
本专栏探讨WSR方法和范例对临床实践和研究社区的潜在影响，这些社区试图成功实施并衡量基于价值的医疗保健的复杂性。具体讨论了四个可能相互关联的主题：以复杂行为为重点的干预措施、以患者为中心的结果、团队协作式护理以及恢复力和幸福感。
临床医生和研究人员利用WSR文献中的方法、范例和经验教训来改善护理、制定更强大的研究策略以及促进TCIM与传统医学社区之间对话的时机已经成熟。
