在沙特医疗保健系统中采用三重目标框架：一项德尔菲研究。
Adopting the Triple Aim Framework in the Saudi Healthcare System: A Delphi Study.
作者信息
Al Jasser Bandar, Almoajel Alia
机构信息
Department of Health Administration, College of Business Administration, Master's Degree Program in Health and Hospital Administration, King Saud University, Riyadh, Saudi Arabia.
Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
出版信息
Risk Manag Healthc Policy. 2020 Oct 19;13:2189-2197. doi: 10.2147/RMHP.S251008. eCollection 2020.
PURPOSE
Helping healthcare systems to optimize performance using particular metrics through objective monitoring will positively impact an organization's progress toward strategic goals and objectives. The Institute of Healthcare Improvement introduced the Triple Aim framework for guiding new or transforming health systems, concurrently improving population health and patients' care experience, and reducing per capita cost. Consensus to determine applicable and appropriate measures to monitor this transformation within the scope of the three objectives is required. Thus, the study aimed to adopt the Triple Aim measures and reach a consensus among experts in healthcare systems on the applicability of the measures in the health system of Saudi Arabia.
METHODS
A two-round Delphi study was conducted with 17 invited experts who were knowledgeable and experienced in healthcare systems and administration, quality improvement, and strategic planning. These rounds were based on the measures of the three objectives, where they were introduced as statements and grouped under each respective aim. The experts were instructed to score each measure using a 5-point Likert scale and were invited to formulate new measures related to the same aim. Statements reaching a consensus level of 80% were considered applicable measures for the Saudi health system.
RESULTS
A total of 17 measures were circulated among experts; out of which, 16 measures reached a consensus. The 16 measures represent the three main domains of the Triple Aim model, ie, population health, experience of care, and cost per capita. The measure that failed to reach a consensus was the predictive model scores because it requires medical knowledge, where the majority of the experts were non-physicians.
CONCLUSION
A Delphi study was used to reach consensus among experts on the Triple Aim measures as a first step to building a solid foundation for the population management required to implement these initiatives in the future.
目的
通过客观监测，帮助医疗保健系统利用特定指标优化绩效，这将对组织朝着战略目标前进产生积极影响。医疗保健改进研究所引入了三重目标框架，以指导新建或转型的卫生系统，同时改善人群健康状况和患者的护理体验，并降低人均成本。需要就确定在这三个目标范围内监测这种转型的适用和适当措施达成共识。因此，本研究旨在采用三重目标措施，并在医疗保健系统专家中就这些措施在沙特阿拉伯卫生系统中的适用性达成共识。
方法
对17位受邀专家进行了两轮德尔菲研究，这些专家在医疗保健系统与管理、质量改进和战略规划方面知识渊博且经验丰富。这两轮研究基于三个目标的措施，这些措施以陈述形式呈现，并按各自的目标进行分组。专家们被要求使用5点李克特量表对每项措施进行评分，并被邀请制定与同一目标相关的新措施。达成80%共识水平的陈述被视为沙特卫生系统的适用措施。
结果
共有17项措施在专家中传阅；其中16项措施达成了共识。这16项措施代表了三重目标模型的三个主要领域，即人群健康、护理体验和人均成本。未达成共识的措施是预测模型得分，因为它需要医学知识，而大多数专家不是医生。
结论
采用德尔菲研究在专家中就三重目标措施达成共识，这是为未来实施这些举措所需的人群管理奠定坚实基础的第一步。
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