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重症患者のケアを改善する: 医療制度と医療制度のアプローチ
1Clinical Research, Investigation and Systems Modeling of Acute Illness (CRISMA) Laboratory, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. angusdc@ccm.upmc.edu
Lancet (London, England)
|April 20, 2004
まとめ
集中治療の改善には,制度的戦略とベッドサイドケアを組み合わせた多面的なアプローチが必要です. 教育,ガイドライン,パフォーマンス報告,インセンティブ,システム再編の組み合わせが持続的な影響のために推奨されます.
科学分野:
- クリティカルケア・メディシン
- 医療サービス 研究 医療サービス
- 保健政策 保健政策 保健政策
背景:
- 臨界医療の提供は,需要の増加とコストプレッシャーによる課題に直面しています.
- ベッドサイド戦略だけでは,重症患者の最適なケアには不十分です.
- 制度的および医療制度のアプローチは,患者のケアを直接するための重要な補足です.
研究 の 目的:
- 集中治療の改善のための制度的および医療システム戦略の見直しをすること.
- 米国と英国の重症患者のケアを強化するための効果的なアプローチを特定する.
- 集中治療の提供を最適化するための包括的な戦略を推奨する.
主な方法:
- 米国と英国の7つの制度的およびシステムレベルのアプローチの集中的なレビュー.
- 教育の分析,組織ガイドライン,業績報告,インセンティブ,規制,法的要件,システム再編.
- 集中治療の改善のための現在のイニシアチブと将来の方向性の検討.
主要な成果:
- 持続的な改善を保証する単一のアプローチはなく,組み合わせが必要である.
- 金融インセンティブに関連した業績報告は,有望な結果を示しています.
- 公共教育と組織ガイドライン (例えば,ICUの入院基準,人事) が推奨されます.
- 地域的ケアと医師の延長器の使用を含む基本的なサービスの再編は不可欠です.
結論:
- 集中治療の持続的な改善には,複数の機関およびシステムレベルの介入を組み合わせた戦略が必要である.
- パフォーマンス報告,公衆教育,および組織ガイドラインの継続的な開発が推奨されます.
- 地域化や先進医療従事者の利用拡大など,医療サービスの根本的な再編は,最適な重症治療の提供に不可欠です.
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