美国人的初级保健家庭:把房子整理好
Kevin Grumbach1, Thomas Bodenheimer
1San Francisco General Hospital, Ward 83, 1001 Potrero Ave, San Francisco, CA 94110, USA. tbodie@earthlink.net
JAMA
|August 21, 2002
概括
美国的初级保健面临重大挑战,包括医生压力和慢性疾病管理不良. 重新设计对于改善患者护理的准入,质量和连续性至关重要.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 主要护理医学 医疗保健
- 医疗保健管理的管理
背景情况:
- 美国医疗保健系统在提供可访问和协调的初级保健方面面临重大挑战.
- 患者希望一贯的初级保健医生 (PCP) 来管理他们的健康需求.
- 目前的初级保健模式因医生工作量和系统效率低下而受到压力.
研究的目的:
- 概述美国初级保健所面临的关键挑战.
- 确定导致初级保健服务受到威胁的因素.
- 倡导对初级保健进行根本性的重新设计,以提高质量和获得.
主要方法:
- 这篇文章对当前初级保健状况进行了定性分析.
- 它综合了有关初级保健挑战的现有文献和专家意见.
- 重点是识别系统性问题,而不是经验数据收集.
主要成果:
- 主要护理受到医生倦怠的威胁,导致压力和护理质量下降.
- 慢性疾病的管理不足以及缺乏及时的接入/连续性是关键问题.
- 目前的系统很难满足患者对协调健康家庭的需求.
结论:
- 迫切需要对初级保健进行根本性的重新设计.
- 改善护理的获取,质量和连续性至关重要.
- 解决方案必须有效地解决医生的工作量和医疗保健成本.
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