Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Geisinger Medical Center, School of Medicine, Danville, Pennsylvania, United States of America.
PLoS One. 2022 Jul 13;17(7):e0271122. doi: 10.1371/journal.pone.0271122. eCollection 2022.
Patients, healthcare providers and insurers need a governance framework to establish the 'rules of use' to deliver more responsible use of services. The objective of this review was to provide an overview of frameworks and analyze the definitions of patient accountability to identify themes and potential gaps in the literature. Fifteen bibliographic databases were searched until July 2021. This included: MEDLINE, EMBASE, CINAHL, PsycINFO, SPORTDiscus, Allied and Complementary Medicine Database, Web of Science, HealthSTAR, Scopus, ABI/INFORM Global, Cochrane Library, ERIC, International Bibliography of the Social Sciences, Sociological Abstracts, Worldwide Political Science Abstracts and International Political Science Abstracts. Searches were also completed in Google Scholar. Inclusion criteria included articles focused on accountability of patients, and exclusions included articles that were not available, not written in English, with missing information, and commentaries or editorials. In total, 85530 unique abstracts were identified, and 27 articles were included based on the inclusion criteria. The results showed that patient accountability is rarely used and poorly defined. Most studies focused on what patients should be held to account for and agreed that patients should be responsible for behaviours that may contribute to adverse health outcomes. Some studies promoted a punitive approach as a mechanism of enforcement. Most studies argued for positive incentives or written agreements and contracts. While many studies recognized the value of patient accountability frameworks, there was a concern that these frameworks could further exacerbate existing socioeconomic disparities and contribute to poor health-related behaviours and outcomes (e.g., stigmatizing marginalized groups). Shared models of accountability between patients and healthcare providers or patients and communities were preferred. Before committing to a patient accountability framework for improving patient health and sustaining a healthcare system, the concept must be acceptable and reasonable to patients, providers, and society as a whole.
患者、医疗保健提供者和保险公司需要一个治理框架来制定“使用规则”，以实现更负责任地使用服务。本次审查的目的是提供一个框架概述，并分析患者问责制的定义，以确定文献中的主题和潜在差距。在 2021 年 7 月之前，我们在 15 个文献数据库中进行了搜索。其中包括：MEDLINE、EMBASE、CINAHL、PsycINFO、SPORTDiscus、辅助和补充医学数据库、Web of Science、HealthSTAR、Scopus、ABI/INFORM Global、Cochrane 图书馆、ERIC、国际社会科学文献目录、社会学摘要、全球政治学文摘和国际政治学文摘。还在 Google Scholar 中进行了搜索。纳入标准包括关注患者问责制的文章，排除标准包括不可用、非英文、信息缺失以及评论或社论的文章。总共确定了 85530 个独特的摘要，根据纳入标准，有 27 篇文章被纳入。结果表明，患者问责制很少被使用且定义不佳。大多数研究都集中在患者应该承担什么责任上，并一致认为患者应对可能导致不良健康结果的行为负责。一些研究提倡惩罚性方法作为执行机制。大多数研究认为积极的激励措施或书面协议和合同是有益的。虽然许多研究都认识到患者问责制框架的价值，但人们担心这些框架可能会进一步加剧现有的社会经济差距，并导致不良的与健康相关的行为和结果（例如，使边缘化群体受到歧视）。患者与医疗保健提供者或患者与社区之间的共同问责模式更受欢迎。在承诺采用改善患者健康和维持医疗体系的患者问责制框架之前，这一概念必须得到患者、提供者和整个社会的认可和合理接受。
