实施以价值为基础的医疗保健:对可持续医疗保健系统的关键要素,结果和挑战进行范围审查
Hanan Khalil1, Mary Ameen2, Charles Davies1
1Department of Public Health, La Trobe University, Bundoora, VIC, Australia.
Frontiers in public health
|April 24, 2025
概括
基于价值的医疗保健 (VBHC) 采用面临资金和阻力等障碍,尽管它有可能改善结果. 关键的促进者包括领导力和数字工具,以成功实施.
科学领域:
- 医疗保健管理的管理
- 卫生经济学 卫生经济学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 基于价值的医疗保健 (VBHC) 是一种模式转变,专注于最大限度地提高与护理成本相关的健康结果.
- 尽管采用越来越多,但仍有重大障碍阻碍了VBHC的实施,包括护理模式的适应,利益相关者的参与和结果测量的标准化.
- 缺乏标准化的结果指标和财务可持续性模型使转向VBHC变得复杂.
研究的目的:
- 进行范围审查,绘制基于价值的医疗保健现有文献的地图.
- 识别和分析与VBHC相关的种群,研究特征,资金模式,结果措施和障碍/促进者.
- 通过了解采用因素,为更广泛的VBHC实施提供政策和实践信息.
主要方法:
- 根据JBI方法和PRISMA-ScR指南进行了范围审查.
- 在9个数据库中进行了搜索,包括以英语出版的同行评审的定量和定性研究.
- 在选了2,725项研究后,共包括了145项研究.
主要成果:
- 美国领先于VBHC研究 (65%的研究),主要的研究设计是队列和横截面.
- 基于价值的采购和基于时间的活动成本是常见的融资模式;传统的医院护理和远程医疗是关键的交付模式.
- 障碍包括资金不足和专业人士的抵抗,而促进者则涉及强有力的领导力和数字工具.
结论:
- 一致的结果测量,财务激励和数据透明度对于可扩展的VBHC实施至关重要.
- 虽然VBHC对医疗保健的效率和质量提升具有前途,但财务和运营协调仍然是一个挑战.
- 需要进一步的研究和政策制定,以克服实施障碍,并充分发挥VBHC的潜力.
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