Clinical and community delivery systems for preventive care: an integration framework.
Clinical and community delivery systems for preventive care: an integration framework.
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预防性护理的临床和社区提供系统：集成框架。
DOI：
10.1016/j.amepre.2013.06.008
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发表时间：
2013-10
影响因子：
5.5
通讯作者：
Anderson LA
中科院分区：
文献类型：
--
作者：
Krist AH;Shenson D;Woolf SH;Bradley C;Liaw WR;Rothemich SF;Slonim A;Benson W;Anderson LA
尽管临床预防服务（CPS）——筛查测试、免疫接种、健康行为咨询和预防性药物——可以挽救生命，但美国人只接受了推荐服务的一半。这一“预防差距”如果消除，将大大降低发病率和死亡率。在临床和社区环境中都有机会改善CPS的提供，但这些活动很少在这些环境中协调，导致效率低下和效益减弱。通过文献综述、对50位国家专家的半结构化访谈、对53个成功项目的实地观察，以及一次国家利益相关者会议，我们制定了一个框架，将CPS交付完全整合到临床和社区护理交付系统中。该框架确定了必要的参与者、他们在医疗服务中的作用，以及确保成功所需的基础设施、支持和政策。整合的主要利益相关者包括临床医生；社区成员和组织；跨越人员和基础设施；国家、州和地方领导；以及资助者和购买者。跨越人员和基础设施对于将临床医生和社区聚集在一起并帮助患者在各个护理环境中导航至关重要。临床-社区整合的具体情况因所处理的服务和当地情况而异。虽然广泛建立有效的临床-社区整合将需要实质性的改变，现有的临床和社区模式提供了一个重要的起点。框架的关键策略和元素通常已经到位，或者很容易识别。对于利益相关者来说，更大的挑战是认识到一体化如何服务于他们的共同利益，以及如何在一段时间内为其提供资金和维持。
Although clinical preventive services (CPS)—screening tests, immunizations, health behavior counseling, and preventive medications—can save lives, Americans receive only half of recommended services. This "prevention gap," if closed, could substantially reduce morbidity and mortality. Opportunities to improve delivery of CPS exist in both clinical and community settings, but these activities are rarely coordinated across these settings, resulting in inefficiencies and attenuated benefits. Through a literature review, semi-structured interviews with 50 national experts, field observations of 53 successful programs, and a national stakeholder meeting, a framework to fully integrate CPS delivery across clinical and community care delivery systems was developed. The framework identifies the necessary participants, their role in care delivery, and the infrastructure, support, and policies necessary to ensure success. Essential stakeholders in integration include clinicians; community members and organizations; spanning personnel and infrastructure; national, state, and local leadership; and funders and purchasers. Spanning personnel and infrastructure are essential to bring clinicians and communities together and to help patients navigate across care settings. The specifics of clinical–community integrations vary depending on the services addressed and the local context. Although broad establishment of effective clinical–community integrations will require substantial changes, existing clinical and community models provide an important starting point. The key policies and elements of the framework are often already in place or easily identified. The larger challenge is for stakeholders to recognize how integration serves their mutual interests and how it can be financed and sustained over time.