Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, 227 E 30th St, Room 633, New York, NY, 10016, USA.
Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA.
BMC Health Serv Res. 2022 Jun 30;22(1):845. doi: 10.1186/s12913-022-08225-6.
As health care spending reaches unsustainable levels, improving value has become an increasingly important policy priority. Relatively little research has explored factors driving value. As a first step towards filling this gap, we performed a scoping review of the literature to identify potential drivers of health care value.
Searches of PubMed, Embase, Google Scholar, Policy File, and SCOPUS were conducted between February and March 2020. Empirical studies that explored associations between any range of factors and value (loosely defined as quality or outcomes relative to cost) were eligible for inclusion. We created a template in Microsoft Excel for data extraction and evaluated the quality of included articles using the Critical Appraisal Skills Programme (CASP) quality appraisal tool. Data was synthesized using narrative methods.
Twenty-two studies were included in analyses, of which 20 focused on low value service utilization. Independent variables represented a range of system-, hospital-, provider-, and patient-level characteristics. Although results were mixed, several consistent findings emerged. First, insurance incentive structures may affect value. For example, patients in Accountable Care Organizations had reduced rates of low value care utilization compared to patients in traditionally structured insurance plans. Second, higher intensity of care was associated with higher rates of low value care. Third, culture is likely to contribute to value. This was suggested by findings that recent medical school graduation and allopathic training were associated with reduced low value service utilization and that provider organizations had larger effects on value than did individual physicians.
System, hospital, provider, and community characteristics influence low value care provision. To improve health care value, strategies aiming to reduce utilization of low value services and promote high value care across various levels will be essential.
随着医疗保健支出达到不可持续的水平，提高价值已成为一个日益重要的政策重点。相对较少的研究探讨了推动价值的因素。作为填补这一空白的第一步，我们对文献进行了范围综述，以确定医疗保健价值的潜在驱动因素。
在 2020 年 2 月至 3 月期间，对 PubMed、Embase、Google Scholar、Policy File 和 SCOPUS 进行了搜索。有资格纳入的实证研究探讨了任何范围的因素与价值（广义上定义为质量或结果与成本的关系）之间的关联。我们在 Microsoft Excel 中创建了一个数据提取模板，并使用批判性评估技能计划（CASP）质量评估工具评估了纳入文章的质量。使用叙述方法对数据进行综合。
22 项研究被纳入分析，其中 20 项研究侧重于低价值服务的利用。自变量代表了一系列系统、医院、提供者和患者层面的特征。尽管结果参差不齐，但出现了一些一致的发现。首先，保险激励结构可能会影响价值。例如，与传统结构保险计划中的患者相比，参与问责医疗组织的患者低价值护理利用率降低。其次，护理强度与低价值护理的高发生率相关。第三，文化可能会对价值产生影响。这一点从最近的医学院毕业和顺势疗法培训与减少低价值服务利用率有关的发现以及医疗机构对价值的影响大于单个医生的发现中得到了证明。
系统、医院、提供者和社区特征影响低价值护理的提供。为了提高医疗保健价值，旨在减少低价值服务的利用并在各个层面促进高价值护理的策略将是必不可少的。
