Redefining global health-care delivery
Redefining global health-care delivery
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DOI：
10.1016/s0140-6736(13)61047-8
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发表时间：
2013-09-21
期刊：
影响因子：
168.9
通讯作者：
Porter, Michael E.
中科院分区：
文献类型：
--
作者：
Kim, Jim Yong;Farmer, Paul;Porter, Michael E.
过去十年来，旨在解决那些面临贫困和严重疾病的人们未得到满足的需求的举措已显着扩大。但其中许多都是以特殊方式设计的，旨在解决众多健康问题中的一个；他们很少被评估；最佳实践传播缓慢。当确实进行实施评估时，它们通常是对单一干预措施的成本效益的狭隘研究，而不是为患者及其家人提供价值所需的复杂的一组干预措施。我们提出了一个全球卫生保健提供和评估框架，考虑了将艾滋病毒/艾滋病护理引入资源匮乏地区的努力。该框架引入了护理服务价值链的概念，该概念将系统级分析应用于整个医疗保健系统中随着时间的推移而必须发生的复杂流程和干预措施，以便为艾滋病毒/艾滋病患者和从结核病到营养不良等并发疾病的患者提供高价值护理。为了交付价值，垂直或独立项目必须集成到共享交付基础设施中，以便明智地使用人员和设施并获得规模经济。对于交付和评估全球卫生价值而言，另外两个综合过程也是必要的：一是通过纳入对取得良好结果的障碍（从营养不良到缺乏水和卫生设施）以及健康和福祉的更广泛的社会和经济决定因素（就业、住房、有形基础设施）的了解，使交付与当地情况保持一致。第二个是利用医疗服务方面的有效投资来促进公平的经济发展，特别是对于那些与贫困和高疾病负担作斗争的人。最后，我们报告了我们自己的共同经验，即通过利用研究和培训来理解和改善护理服务，寻求向服务科学迈进。
Initiatives to address the unmet needs of those facing both poverty and serious illness have expanded signifi cantly over the past decade. But many of them are designed in an ad-hoc manner to address one health problem among many; they are too rarely assessed; best practices spread slowly. When assessments of delivery do occur, they are often narrow studies of the cost-eff ectiveness of a single intervention rather than the complex set of them required to deliver value to patients and their families. We propose a framework for global health-care delivery and evaluation by considering eff orts to introduce HIV/AIDS care to resource-poor settings. The framework introduces the notion of care delivery value chains that apply a systems-level analysis to the complex processes and interventions that must occur, across a health-care system and over time, to deliver high-value care for patients with HIV/AIDS and cooccurring conditions, from tuberculosis to malnutrition. To deliver value, vertical or stand-alone projects must be integrated into shared delivery infrastructure so that personnel and facilities are used wisely and economies of scale reaped. Two other integrative processes are necessary for delivering and assessing value in global health: one is the alignment of delivery with local context by incorporating knowledge of both barriers to good outcomes (from poor nutrition to a lack of water and sanitation) and broader social and economic determinants of health and wellbeing (jobs, housing, physical infrastructure). The second is the use of eff ective investments in care delivery to promote equitable economic development, especially for those struggling against poverty and high burdens of disease. We close by reporting our own shared experience of seeking to move towards a science of delivery by harnessing research and training to understand and improve care delivery.