Bréchat Pierre-Henri, Rasmusson Kismet, Briot Pascal, Foury Christian, Fulton Ross, Smith Doug, Roberts Colleen, Lapp Donald
Sante Publique. 2018 November-December;30(6):877-885. doi: 10.3917/spub.187.0877.
Among chronic diseases, heart failure is a top public health priority both in France and in the United States. If progress is possible in France, the experience from Intermountain Healthcare (IH), in the United States can be a source of significant experimentations.
To identify the teaching of the clinical integration of the specialists in the field of heart failure with the primary care sector which could be useful in France.
This research is based on the qualitative analysis of data resulting from the work between experts, of bibliographical research, and of some groupings by item corresponding to the objectives of the Triple Aim from the Institute for Healthcare Improvement (IHI).
The program of the integrated care delivery system for heart failure of Intermountain Healthcare reaches the objectives of the Triple Aim from the IHI, that is to say, the enhancement of the health of the population, improving quality of care and the satisfaction of the user, and the reduction of the cost of care. This program also enhances the Chronic Care Model by integrating a team of specialists in the field of heart failure, building up a pluridisciplinary team focused on the need of both the patients and their families. This creates a multidisciplinary care delivery system for heart failure which is global, protocolized, stratified, planned and followed. The prevention and the ambulatory care integrating the specialized care of second stage to the care of first stage are developed. The users and their families are co-responsible for their health. The systematic evaluation is based on the specific indicators.
This program improves the effectiveness of care while improving organizational efficiency resulting in savings for IH Health Plan (SelectHealth). It also enhances the equality of access to better healthcare and health for the entire population.
在慢性病中，心力衰竭在法国和美国都是首要的公共卫生重点问题。如果法国有可能取得进展，美国山间医疗保健公司（Intermountain Healthcare，简称IH）的经验可成为重要的试验来源。
确定心力衰竭领域专家与基层医疗部门临床整合方面的经验教训，这可能对法国有用。
本研究基于对专家之间工作、文献研究以及与医疗保健改进研究所（IHI）三重目标相对应的按项目分组数据的定性分析。
山间医疗保健公司心力衰竭综合护理提供系统项目实现了IHI的三重目标，即改善人群健康、提高护理质量和用户满意度以及降低护理成本。该项目还通过整合心力衰竭领域的专家团队，增强了慢性病护理模式，建立了一个关注患者及其家庭需求的多学科团队。这创建了一个针对心力衰竭的多学科护理提供系统，该系统是全面的、有规范的、分层的、有计划的且可跟踪的。预防和门诊护理得到发展，将二级专科护理整合到一级护理中。用户及其家庭对自身健康共同负责。系统评估基于特定指标。
该项目提高了护理效果，同时提高了组织效率，为IH健康计划（SelectHealth）节省了成本。它还增强了全体人口获得更好医疗保健和健康的平等机会。
