评估美国县卫生保健系统的表现和关键相关因素 (2014-19年):三重目标框架分析
Haley Lescinsky1, Meera Beauchamp1, Catherine Bisignano1
1Institute for Health Metrics and Evaluation, Hans Rosling Center for Population Health, Seattle, WA, USA.
美国各县在实现患者体验,健康成果和成本降低的三重目标方面存在差异. 管理护理和扩大医疗补助等政策与更好的表现有关.
科学领域:
- 医疗服务研究
- 公共卫生政策
背景情况:
- 三重目标 (积极的患者体验,健康结果,低支出) 是医疗保健的关键目标.
- 与其他国家相比, 美国的医疗保健支出很高,
- 美国各州和各县的医疗保健表现存在显著差异.
研究的目的:
- 量化美国各县实现三重目标的进展情况.
- 确定与医疗保健系统高绩效相关的政策因素.
主要方法:
- 使用2014-2019年县级数据进行生态分析.
- 评估患者经验 (综合指标),健康结果 (预期寿命) 和支出 (人均支出).
- 计算了未调整的和调整的绩效分数,控制县的特点;用于政策因素分析的线性回归.
主要成果:
- 较高的未调整表现与受过教育,较富裕的人口,城市环境以及较低的肥胖/吸烟率相关.
- 经过调整后,罗德岛,爱荷华州,弗吉尼亚州和夏威夷州的进步最为明显.
- 哥伦比亚特区,阿拉斯加,特拉华州,密西西比州和俄克拉荷马州的分数最低.
- 管理护理,扩大医疗补助和竞争性市场与更好的三重目标进展有关.
结论:
- 确定了美国各县的重大卫生系统差异和与政策相关的绩效差异.
- 调查结果可以为旨在降低成本,改善护理获取/质量和改善健康成果的政策制定者提供信息.
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