医疗计划事先授权对临床有效性和患者结果的不良影响:系统性审查
Jacob Murphy1, Norman Beauchamp1, Kristi J Sun1
1Russell H. Morgan Department of Radiology and Radiological Science.
The American journal of medicine
|September 5, 2025
概括
预先授权的要求在医疗保健中造成了重大障碍,导致治疗延迟,疾病恶化和患者的治疗结果恶化. 这一系统审查强调了与这些保险计划任务相关的可衡量的患者伤害.
科学领域:
- 医疗服务研究
- 临床结果
- 医疗保健政策
背景情况:
- 医疗保险计划的预先授权 (PA) 对美国的高效医疗服务构成越来越大的挑战.
- 医生报告PA要求对临床效率,患者/提供者经验和患者结果产生负面影响.
研究的目的:
- 系统地审查和综合有关事先授权对疾病管理和患者结果的不利影响的已公布证据.
- 整合不同医学专业的研究成果.
主要方法:
- 对25项已发表的研究进行系统审查.
- 对事先授权对疾病进展和患者健康的影响的证据分析.
- 包括各种专业的研究,如瘤学,心脏病学,行为健康和儿科.
主要成果:
- 预先授权与严重的护理延误有关.
- 有证据表明,高血压与疾病恶化,可预防的住院和长时间住院有关.
- 在受先授权程序影响的患者中观察到较低的无病存活率.
结论:
- 已公布的证据表明,由于事先授权,在多个医疗保健领域对患者造成了可衡量的伤害.
- 需要为健康计划制定国家质量指标,以追踪纵向结果.
- 建议使用索赔数据来更好地量化PA延迟和拒绝造成的损害.
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