实施以价值为导向的结果计划,以确定临床成本和结果的高变化以及与成本降低和质量改善的关联
Vivian S Lee1, Kensaku Kawamoto1, Rachel Hess1
1University of Utah, Salt Lake City.
JAMA
|September 14, 2016
概括
一个以价值为导向的结果工具有助于降低医疗保健成本并改善特定临床项目的患者结果. 医生了解实际的成本和结果可以提高个体患者的护理.
科学领域:
- 医疗服务研究
- 健康经济学
- 改善临床质量
背景情况:
- 美国的医疗保健系统正在从以数量为基础的医疗服务转变为以价值为基础的医疗服务.
- 在个体患者层面准确衡量成本和结果对于这一转变至关重要.
研究的目的:
- 评估价值驱动结果工具对降低成本和优化健康结果的影响.
- 该工具将成本和质量指标分配给个别患者.
主要方法:
- 2012年至2016年在犹他大学进行了一项不受控制的前后纵向观察性研究.
- 医生与过程改进专家合作,利用提供结果,成本和变化数据的工具.
- 关键指标包括直接成本,成本变化 (变化系数) 和复合质量指数.
主要成果:
- 在整体关节更换方面,质量指数从54%提高到80%,平均直接成本在实施后下降了11%.
- 医院的实验室检测成本每天下降15美元.
- 对于败血症,抗感染剂的平均时间减少了4. 1小时.
结论:
- 在大型医疗系统中实施以价值为导向的结果工具降低了成本,并在选定的临床领域提高了质量.
- 为医生提供实际的患者成本和结果数据可能有利于临床决策和护理.
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