High and rising health care costs. Part 4: Can costs be controlled while preserving quality?
High and rising health care costs. Part 4: Can costs be controlled while preserving quality?
复制标题
DOI：
10.7326/0003-4819-143-1-200507050-00007
复制
发表时间：
2005-07-05
影响因子：
39.2
通讯作者：
Fernandez, A
中科院分区：
文献类型：
--
作者：
Bodenheimer, T;Fernandez, A
已经提出了几种涉及医生领导和参与的相互关联的战略，以在保持或提高质量的同时控制医疗成本。这些计划包括针对10%的人口的计划，这些计划产生了70%的医疗保健支出，疾病管理计划以防止慢性疾病代价高昂的并发症，努力减少医疗差错，加强初级保健实践，决策支持工具以避免不适当的服务，以及改进技术评估的传播。降低成本、提高质量的计划的一个例子是为因充血性心力衰竭而反复住院的高风险患者进行医院后护士监测和干预。针对慢性病人群的疾病管理计划，而不是专注于高使用率的个人，可能在提高质量方面有效，但可能不会降低成本。减少差错在降低成本的同时提高质量具有巨大的潜力，尽管可能的成本降低只占全国医疗保健支出的一小部分。获得初级保健已被证明与减少医院使用有关，同时保持质量。通过消息灵通的医生和患者之间的共同决策，可以减少不适当的护理和过度使用新技术。医生在促进这些有助于减缓医疗保健支出增长的质量提升战略方面发挥着核心作用。
Several interrelated strategies involving physician leadership and participation have been proposed to contain health care costs while preserving or improving quality. These include programs targeting the 10% of the population that incurs 70% of health care expenditures, disease management programs to prevent costly complications of chronic conditions, efforts to reduce medical errors, the strengthening of primary care practice, decision support tools to avoid inappropriate services, and improved diffusion of technology assessment.An example of a cost-reducing, quality-enhancing program is post-hospital nurse monitoring and intervention for patients at high risk for repeated hospitalization for congestive heart failure. Disease management programs that target groups with a chronic condition rather than focusing efforts on high-utilizing individuals may be effective in improving quality but may not reduce costs. Error reduction has great potential to improve quality while reducing costs, although the probable cost reduction is a small portion of national health care expenditures. Access to primary care has been shown to correlate with reduced hospital use while preserving quality. Inappropriate care and overuse of new technologies can be reduced through shared decision-making between well-informed physicians and patients. Physicians have a central role to play in fostering these quality-enhancing strategies that can help to slow the growth of health care expenditures.