Department of Medicine , University of Washington School of Medicine, Seattle, WA, USA.
VA Puget Sound Healthcare System, Seattle, WA, USA.
J Gen Intern Med. 2019 Nov;34(11):2634-2636. doi: 10.1007/s11606-019-05285-z. Epub 2019 Aug 26.
One increasingly popular strategy for addressing avoidable healthcare costs is to couple "hotspotting" with interventions that deliver expanded, more intense primary care services to high-cost patient populations. While there is rationale for such intensive primary care programs, early results have been lackluster. Geoffrey Rose's preventive medicine strategy provides insight about a potential explanation: that the narrow scope of these initiatives on small groups of high-cost patients may inherently prevent them from achieving overall cost reductions across entire patient populations. While additional work and results from innovative non-healthcare-based interventions are needed, healthcare organizations may benefit from instead investing in broader interventions that impact patients across cost levels, including average- or low-cost patients.
一种越来越受欢迎的解决可避免医疗成本的策略是将“热点发现”与干预措施相结合，为高成本患者群体提供扩展的、更密集的初级保健服务。虽然这种密集型初级保健方案有其合理之处，但早期的结果却乏善可陈。杰弗里·罗斯的预防医学策略提供了一个潜在解释的见解：这些举措的范围狭窄，只针对一小部分高成本患者，这可能从根本上阻止了它们在整个患者群体中实现总成本的降低。虽然需要更多的工作和来自创新的非医疗保健干预措施的结果，但医疗机构可能会受益于投资于更广泛的干预措施，这些措施会影响各级成本的患者，包括平均或低成本患者。
