Khoo Jia En Joy, Lim Cher Wee, Lai Yi Feng
Ministry of Health (MOH) Office for Healthcare Transformation, Singapore, Singapore.
Department of Life Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore.
Front Health Serv. 2024 Feb 26;3:1147565. doi: 10.3389/frhs.2023.1147565. eCollection 2023.
Given the shift towards value-based healthcare and the increasing recognition of generalist care, enacting value-based healthcare for generalist care is critical. This work aims to shed light on how to conduct performance management of generalist care to facilitate value-based care, with a focus on medical care of hospitalised patients.
A scoping review of published literature was conducted. 30 publications which were relevant to performance management of generalist medical inpatient care were included in the review.
The performance measures used across the studies were analysed and other qualitative findings were also obtained.
We report an overall lack of research on performance management methods for generalist inpatient care. Relevant performance measures found include both outcome and process of care measures and both clinical and reported measures, with clinical outcome measures the most frequently reported. Length of stay, readmission rates and mortality were the most frequently reported. The insights from the papers emphasise the relevance of process of care measures for performance management, the advantages and disadvantages of types of measures and provide suggestions relevant for performance management of generalist inpatient care.
The findings of this scoping review outline a variety of performance measures valuable for generalist inpatient care including clinical outcome measures, reported outcome measures and process of care measures. The findings also suggest directions for implementation of such performance management, including emphasis on physician level performance management and the importance of documentation training. Further research for selecting and operationalising the measures for specific contexts and developing a comprehensive performance management system involving these measures will be important for achieving value-based healthcare for generalist inpatient care.
鉴于医疗保健正朝着基于价值的方向转变，且对全科医疗的认可度不断提高，为全科医疗实施基于价值的医疗保健至关重要。这项工作旨在阐明如何对全科医疗进行绩效管理以促进基于价值的医疗保健，重点关注住院患者的医疗护理。
对已发表的文献进行了范围综述。该综述纳入了30篇与全科医疗住院患者绩效管理相关的出版物。
分析了各项研究中使用的绩效指标，并获取了其他定性研究结果。
我们发现总体上缺乏关于全科住院患者护理绩效管理方法的研究。发现的相关绩效指标包括护理结果指标和护理过程指标，以及临床指标和上报指标，其中临床结果指标的报道最为频繁。住院时间、再入院率和死亡率是报道最为频繁的指标。论文中的见解强调了护理过程指标对绩效管理的相关性、各类指标的优缺点，并为全科住院患者护理的绩效管理提供了相关建议。
本范围综述的结果概述了对全科住院患者护理有价值的各种绩效指标，包括临床结果指标、上报结果指标和护理过程指标。研究结果还为这种绩效管理的实施提供了方向，包括强调医生层面的绩效管理以及文件记录培训的重要性。针对特定背景选择和实施这些指标以及开发包含这些指标的综合绩效管理系统的进一步研究，对于实现全科住院患者护理的基于价值的医疗保健至关重要。
