人口健康价值框架：通过降低慢性病患者群体的医疗成本来创造价值。

The Population Health Value Framework: Creating Value by Reducing Costs of Care for Patient Subpopulations With Chronic Conditions.

机构信息

R. Gupta is interim chief value director, UCLA-Olive View Medical Center, former medical director of quality improvement, UCLA Health, and assistant professor, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California. L. Roh is director for population health, UCLA Health, University of California, Los Angeles, Los Angeles, California. C. Lee is a program manager for population health, UCLA Health, University of California, Los Angeles, Los Angeles, California. D. Reuben is director, Multicampus Program in Geriatrics Medicine and Gerontology, chief, Division of Geriatrics, professor of medicine, and director, UCLA Claude D. Pepper Older Americans Independence Center and Alzheimer's and Dementia Care Program, University of California, Los Angeles, Los Angeles, California. A. Naeim is associate director, Clinical Translational Science Institute, and chief medical officer, Clinical Research, UCLA Campus and Health System, and professor of medicine, Divisions of Hematology-Oncology and Geriatric Medicine, University of California, Los Angeles, Los Angeles, California. J. Wilson is director, Kidney Health Program, Kidney Stone Center and Surgical Consultative Nephrology, UCLA Health, and associate professor, Division of Nephrology, University of California, Los Angeles, Los Angeles, California. S.A. Skootsky is chief medical officer, Faculty Practice Group and Office of Population Health and Accountable Care, UCLA Health, and professor of medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California.

出版信息

Acad Med. 2019 Sep;94(9):1337-1342. doi: 10.1097/ACM.0000000000002739.

DOI:10.1097/ACM.0000000000002739

PMID:31460929

Abstract

PROBLEM

With the growth in risk-based and accountable care organization contracts, creating value by redesigning care to reduce costs and improve outcomes and the patient experience has become an urgent priority for health care systems.

APPROACH

In 2016, UCLA (University of California, Los Angeles) Health implemented a system-wide population health approach to identify patient populations with high expenses and promote proactive, value-based care. The authors created the Patient Health Value framework to guide value creation: (1) identify patient populations with high expenses and reasons for spending, (2) create design teams to understand the patient story, (3) create custom analytics and spending-based risk stratification, and (4) develop care pathways based on spending risk tiers. Primary care patients with three chronic conditions-dementia, chronic kidney disease (CKD), and cancer-were identified as high-cost subpopulations.

OUTCOMES

For each patient subpopulation, a multispecialty, multidisciplinary design team identified reasons for spending and created care pathways to meet patient needs according to spending risk. Larger, lower-risk cohorts received necessary but less intensive interventions, while smaller, higher-risk cohorts received more intensive interventions. Preliminary analyses showed a 1% monthly decrease in inpatient bed day utilization among dementia patients (incident rate ratio [IRR] 0.99, P < .03) and a 2% monthly decrease in hospitalizations (IRR 0.98, P < .001) among CKD patients.

NEXT STEPS

Use of the Patient Health Value framework is expanding across other high-cost subpopulations with chronic conditions. UCLA Health is using the framework to organize care across specialties, build capacity, and grow a culture for value.

摘要

问题

随着基于风险的和问责制医疗组织合同的增长，通过重新设计护理以降低成本、改善结果和患者体验来创造价值，已成为医疗保健系统的当务之急。

方法

2016 年，加州大学洛杉矶分校健康中心（UCLA Health）实施了一项全系统的人群健康方法，以确定高费用患者人群，并促进积极的、基于价值的护理。作者创建了患者健康价值框架来指导价值创造：（1）确定高费用患者人群及其费用支出的原因，（2）创建设计团队以了解患者的情况，（3）创建定制的分析和基于支出的风险分层，以及（4）根据支出风险级别制定护理路径。被确定为高成本亚人群的有三种慢性病（痴呆、慢性肾脏病和癌症）的初级保健患者。

结果

对于每个患者亚人群，一个多专科、多学科的设计团队确定了支出的原因，并根据支出风险创建了满足患者需求的护理路径。较大、风险较低的队列接受了必要但不那么密集的干预，而较小、风险较高的队列则接受了更密集的干预。初步分析显示，痴呆患者的住院日使用率每月下降 1%（发病率比 [IRR]0.99，P <.03），慢性肾脏病患者的住院率每月下降 2%（IRR0.98，P <.001）。