Research to Change Health Delivery Systems: On the Outside Looking in?
Research to Change Health Delivery Systems: On the Outside Looking in?
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改变医疗服务系统的研究：从外部看？
DOI：
10.1007/s11606-018-4586-4
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发表时间：
2018
影响因子：
5.7
通讯作者：
Grant,RichardW
中科院分区：
文献类型：
--
作者：
Gopalan,Anjali;Grant,RichardW
在美国每年花费在医疗保健上的3.3万亿美元中，目前只有不到0.1%用于旨在改善我们提供医疗保健方式的研究。1，2提高医疗服务的有效性和效率不仅对我们的整体经济和医疗支出有影响，而且对我们公民的寿命和生活质量也有影响。改善医疗服务的方式有时会被视为一种偶然的奋进，质量改进（QI）和传统研究之间存在尴尬的重叠。QI方法通常寻求使用学习周期和最初为业务管理开发的其他流程变更技术（例如，计划-执行-学习-行动，精益）来实施先前建立的基于证据的实践。3、4传统研究采用严格但耗时的方法，通过假设驱动的发现来创造新知识。虽然这两种方法在医疗服务的新战略方面经常重叠，但它们在资金来源、对其他医疗机构和患者的可推广性以及改变当前医疗保健系统工作流程的权限方面往往有所不同。发表在本期JGIM上的一项研究强调了在当前医疗保健领域工作的研究人员所面临的一些挑战。5 Ryskina等人试图减少住院患者中常规实验室检查（例如CBC、BMP）的过度排序，这是一个普遍存在的问题，对住院费用和患者的住院经历都有重大影响。6这个问题是一个很好的例子，说明我们需要在如何提供医疗保健方面进行创新研究：常规实验室的过度订购（以及随后可能出现虚假结果的后续检查）对我们的卫生系统有数百万美元的影响，解决这个问题是医院医学学会的五个明智选择活动建议之一。6 Ryskina等人假设，为医生提供社会比较反馈（关于他们的常规实验室订购行为与同行相比的个性化反馈）
O f the more than $3.3 trillion dollars spent annually on health care in the USA, less than 0.1% currently goes towards research designed to improve how we deliver health care. 1, 2 Increasing the effectiveness and efficiency of health care delivery has implications not only for our overall economy and health care spending, but also for the longevity and quality of life of our citizens.Improving the way health care is delivered can sometimes be perceived as a haphazard endeavor with awkward overlap between quality improvement (QI) and traditional research. QI approaches typically seek to implement previously established, evidence-based practices using learning cycles and other process change techniques originally developed for business management (eg, Plan-Do-Study-Act, Lean). 3, 4 Traditional research applies rigorous but time-consuming methods to create new knowledge through hypothesis-driven discovery. While there is frequent overlap between these two approaches when it comes to new strategies for care delivery, they often differ in their sources of funding, generalizability to other health care settings and patients, and their authority to change current health care system workflows. A study published in this issue of JGIM underscores some of the challenges faced by researchers working within this current health care delivery landscape. 5 Ryskina et al. attempted to reduce over-ordering of routine lab tests (eg, CBC, BMP) among hospitalized patients, a ubiquitous problem with significant implications for both hospitalization costs and patients’ hospital experiences. 6 This problem is an excellent example of the need to conduct innovative research in how we deliver health care: Over-ordering of routine labs (and the cascade of subsequent work-ups that can follow spurious results) has multimillion-dollar implications for our health system and addressing this problem is one of the Society of Hospital Medicine’s five Choosing Wisely campaign recommendations. 6 Ryskina et al. hypothesized that providing physicians with social comparison feedback (personalized feedback on how their routine lab ordering behaviors compared to their peers)
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影响因子：
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作者：
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DOI：
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发表时间：
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期刊：
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作者：
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DOI：
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发表时间：
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影响因子：
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作者：
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