Achieving the Quadruple Aim to deliver value-based allergy care in an ever-evolving health care system.
Achieving the Quadruple Aim to deliver value-based allergy care in an ever-evolving health care system.
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DOI：
10.1016/j.anai.2020.04.007
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发表时间：
2020-08
期刊：
影响因子：
--
通讯作者：
Shaker MS
中科院分区：
文献类型：
--
作者：
Iglesia EGA;Greenhawt M;Shaker MS
定义过敏症的价值为基础的护理的概念，并审查过敏症和免疫学家在价值为基础的医疗保健提供的挑战和机遇。文章描述实践的变化，医疗保健融资和报销，共同决策，具有成本效益的医疗保健服务，病人报告的结果措施，健康的社会决定因素和筛查。叙述性回顾，详细介绍了概念和方法，以改善价值为基础的医疗保健的背景下，四个目标，以解决病人和医生的经验，成本和人口健康。通过了解不必要的地理实践差异和基准最佳实践，可以为提高成本效益的护理提供信息。尽管有证据表明，共同决策和解决健康的社会决定因素在高质量的护理中发挥着关键作用，但一些做法，如荨麻疹的常规实验室筛查，预防复发性低渗或等渗造影剂反应的术前用药，对已解决的过敏反应的延长观察，食物过敏筛查和青霉素过敏过度诊断，相对于整体社会效益而言，成本较高。食物过敏预防、新生儿严重联合免疫缺陷筛查和青霉素脱标签是过敏症专家和免疫学家可以协助创造医疗保健价值的基于人群的机会的例子。尽管近年来已经出现了激励基于价值的护理的努力，但过程措施在多大程度上改善了患者重要的结果仍然不确定。临床医生的健康必须成为持续有效实践的优先事项。随着医疗保健系统的不断发展，过敏症专家和免疫学家将通过将新出现的证据转化为实践，并交流预防和治疗过敏性疾病的新方法，在优化价值方面发挥关键作用。
To define the concept of value-based care in allergy, and to review challenges and opportunities in value-based health care delivery for allergists and immunologists. Articles describing practice variation, health care financing and reimbursement, shared decision-making, cost-effective health care delivery, patient-reported outcome measures, social determinants of health, and screening. A narrative review detailing concepts and approaches to improve value-based health care in the context of the Quadruple Aim to address the patient and physician experience, cost, and population health. Efforts to improve cost-effective care can be informed by understanding unwarranted geographic practice variation and benchmarking best practices. Although evidence suggests that shared decision-making and addressing social determinants of health have critical roles in high-quality care, some practices such as routine laboratory screening for urticaria, premedication to prevent recurrent low- or iso-osmolar contrast reactions, extended observation of resolved anaphylaxis, food allergy screening, and penicillin allergy overdiagnosis have high costs in relation to overall societal benefit. Food allergy prevention, newborn screening for severe combined immune deficiency, and penicillin delabeling are examples of population-based opportunities in which allergists and immunologists can assist in creating health care value. Although efforts to incentivize value-based care have emerged in recent years, the degree to which process measures improve patient-important outcomes remain uncertain. Clinician wellness must be made a priority for continued effective practice. As health care systems continue to evolve, allergists and immunologists will play a key role in optimizing value by translating emerging evidence into practice and communicating novel approaches to prevent and treat allergic diseases.
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