Regional collaboration as a model for fostering accountability and transforming health care.
Regional collaboration as a model for fostering accountability and transforming health care.
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区域合作作为促进问责制和转变医疗保健的模式。
DOI：
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发表时间：
2009
影响因子：
2.5
通讯作者：
E. Fonner
中科院分区：
文献类型：
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作者：
A. Speir;J. Rich;I. Crosby;E. Fonner
预算限制日益增加，支付者和提供者不一致，以及美国卫生成果被资金不足的国家超过的竞争性制度，促使决策者寻求更有效的手段来促进具有成本效益的服务和问责制。本文阐述了一种有效的区域协作工作模式，其重点是改善心血管外科护理的健康结果、控制成本和有效利用资源。维吉尼亚心脏外科质量倡议是维吉尼亚心脏外科医生和医院提供者之间长达十年的合作，旨在通过分析比较数据、确定最佳表现和在全州范围内复制最佳临床实践来改善结果并控制成本。该小组的目标和目的，以及两代绩效改进计划，进行了审查。这些包括尝试改善术后结果和使用决策支持和建模工具。这项工作使该小组赞成采用一种更加综合的办法来改进业绩，并制订了注重质量的支付制度的原则。这种合作促进了区域问责制，从而在具有成本效益的基础上提供高质量的医疗服务。弗吉尼亚心脏外科质量倡议尝试测试全球定价模式，并实施了一项按绩效付费的计划，使医生和医院在共同目标上保持一致。虽然这种合作方式还在进行中，但作者指出了适用于其他地区和医学专业的先决条件。需要制定一份短期后续步骤的路线图，以创建一个与改革交付系统的国家议程相联系的适应性支付系统。
An era of increasing budgetary constraints, misaligned payers and providers, and a competitive system where United States health outcomes are outpaced by less well-funded nations is motivating policy-makers to seek more effective means for promoting cost-effective delivery and accountability. This article illustrates an effective working model of regional collaboration focused on improving health outcomes, containing costs, and making efficient use of resources in cardiovascular surgical care. The Virginia Cardiac Surgery Quality Initiative is a decade-old collaboration of cardiac surgeons and hospital providers in Virginia working to improve outcomes and contain costs by analyzing comparative data, identifying top performers, and replicating best clinical practices on a statewide basis. The group's goals and objectives, along with 2 generations of performance improvement initiatives, are examined. These involve attempts to improve postoperative outcomes and use of tools for decision support and modeling. This work has led the group to espouse a more integrated approach to performance improvement and to formulate principles of a quality-focused payment system. This is one in which collaboration promotes regional accountability to deliver quality care on a cost-effective basis. The Virginia Cardiac Surgery Quality Initiative has attempted to test a global pricing model and has implemented a pay-for-performance program where physicians and hospitals are aligned with common objectives. Although this collaborative approach is a work in progress, authors point out preconditions applicable to other regions and medical specialties. A road map of short-term next steps is needed to create an adaptive payment system tied to the national agenda for reforming the delivery system.