Koo Alec S, Jacoby Dana L
Skyline Urology, Torrance, California.
DJI Consulting, Davidson, North Carolina.
Urol Pract. 2018 Jul;5(4):245-252. doi: 10.1016/j.urpr.2017.06.003. Epub 2017 Jun 13.
Patient centered medical homes have been traditionally viewed as the most logical model for the treatment and coordination of care for individuals with various conditions, although there are certain diseases for which urology groups in the form of patient centered specialty practices are better suited. We assessed the current state of urology involvement in the patient centered medical home to suggest implementation strategies for which urology based, patient centered specialty practices should be the primary contact for advanced disease states.
We conducted a review of published studies using PubMed®/MEDLINE® from database inception to 2017. Studies that contained data on urology involvement in patient centered medical homes were included, as well as governmental and agency produced reports.
There is a consensus in the literature regarding an escalation of cancer care costs that are not linked to improved patient satisfaction or outcomes. Emphasis is now being placed on innovative treatment models in oncology that are based on the patient centered model and alternative, value based payments as opposed to the traditional fee-for-service approach. The oncology medical home, in the form of a patient centered specialty practice, may mitigate some of the financial burden while providing a higher quality of care and improved patient satisfaction.
By incorporating high quality cancer care standards such as those established by the Health and Medicine Division of the National Academies of Sciences, Engineering and Medicine, and the Centers for Medicare and Medicaid Services urology practices can position themselves as patient centered specialty practice facilities recognized by the National Committee for Quality Assurance, which are capable of becoming the primary medical homes for patients with chronic urological conditions.
以患者为中心的医疗之家传统上被视为治疗和协调患有各种疾病个体护理的最合理模式,尽管对于某些疾病,以患者为中心的专科诊疗形式的泌尿外科团队可能更适合。我们评估了泌尿外科参与以患者为中心的医疗之家的现状,以提出实施策略,对于晚期疾病状态,以泌尿外科为基础、以患者为中心的专科诊疗应作为主要联络点。
我们使用PubMed®/MEDLINE®对从数据库建立到2017年发表的研究进行了综述。纳入了包含泌尿外科参与以患者为中心的医疗之家数据的研究,以及政府和机构发布的报告。
文献中对于癌症治疗成本的上升达成了共识,这种上升与患者满意度或治疗效果的改善无关。目前重点在于肿瘤学中基于以患者为中心模式和替代性、基于价值的支付方式的创新治疗模式,而非传统的按服务收费方式。以患者为中心的专科诊疗形式的肿瘤医疗之家可能在减轻部分经济负担的同时,提供更高质量的护理并提高患者满意度。
通过纳入诸如美国国家科学院、工程院和医学院健康与医学部以及医疗保险和医疗补助服务中心制定的高质量癌症护理标准,泌尿外科诊疗机构可以将自身定位为获得国家质量保证委员会认可的以患者为中心的专科诊疗机构,有能力成为慢性泌尿系统疾病患者的主要医疗之家。