Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
Am J Med. 2023 Sep;136(9):874-877. doi: 10.1016/j.amjmed.2023.04.031. Epub 2023 May 7.
United States health systems face unique challenges in transitioning from volume-based to value-based care, particularly for academic institutions. Providing complex specialty and tertiary care dependent on servicing large geographic areas, and concomitantly meeting education and research academic missions may limit the time and resources available for focusing on the care coordination needs of complex local populations. Despite these challenges, academic medicine is well situated to capitalize on the promise of value-based care and to lead broad improvements in both teaching and nonteaching hospitals. If properly executed, value-based care and complex specialty care can be complementary and synergistic. We postulate that the transition from volume to value in population health requires all health care organizations to advance and formalize infrastructure in 3 core areas: organizational capabilities; provider engagement; and engagement of the patient, family, and community. Although these apply to all organizations, for academic health systems, this transition must also be interwoven with the other domains of the tripartite mission.
美国的医疗体系在从以数量为基础的医疗服务向以价值为基础的医疗服务转变方面面临着独特的挑战，尤其是对于学术机构而言。提供复杂的专科和三级医疗服务依赖于服务于广大地理区域，同时满足教育和研究的学术使命，可能会限制用于关注复杂当地人群的医疗协调需求的时间和资源。尽管存在这些挑战，但学术医学具有很好的优势，可以利用基于价值的医疗服务的优势，并在教学和非教学医院中引领广泛的改善。如果执行得当，基于价值的医疗服务和复杂的专科医疗服务可以相辅相成。我们假设，在人群健康方面，从数量到价值的转变要求所有医疗保健组织在 3 个核心领域推进和正式化基础设施：组织能力；提供者参与；以及患者、家庭和社区的参与。尽管这些适用于所有组织，但对于学术医疗系统而言，这种转变还必须与三方使命的其他领域交织在一起。
