Effecting Change in Chronic Care: The Tipping Point

慢性疾病已经成为美国疾病、残疾和死亡的主要原因，影响了几乎一半的美国人口，并占了这个国家医疗保健支出的大部分。尽管努力提高对慢性病患者的护理质量，但研究继续揭示了这一人群在实践和结果方面的巨大差异。本研究建议将医生、雇主、健康计划和来自地区和国家的私营和公共部门的付款人聚集在一起，进行独特的合作，以实现医疗保健的“临界点”，从而加快美国大部分慢性病患者在门诊环境中提供的护理质量的改善。具体而言，美国医学协会、匹兹堡地区医疗保健倡议、爱荷华州医疗保健基金会、蓝十字和蓝盾协会、医疗保险和医疗补助服务中心以及中西部健康商业集团正在合作建立伙伴关系，以确定必要的基础设施，使医生在治疗糖尿病、重度抑郁症、或者冠状动脉疾病；使数据能够在医生办公室、健康计划和实验室内部和之间收集、检索和传输；通过使用绩效衡量方法，确定医生和其他参与改善慢性病患者护理质量工作的人员所面临的障碍、负担以及激励措施；并确定创建综合数据注册表的可行性，该注册表将能够向医生提供基准数据，并向健康计划和第三方付款人提供汇总数据。实现这些目标的方法包括：在美国两个地区的初级保健医生办公室的精选样本中，调整和实施由医师联盟为糖尿病、重度抑郁症和冠状动脉疾病的绩效改进而开发的绩效测量集；现场识别参与研究的医生、健康计划和实验室的数据能力；对医生、计划、实验室和雇主在测量工具、数据收集和交付过程方面的经验进行评估。

Chronic conditions have become the leading cause of illness, disability, and death in the United States, affect almost half of the U.S. population, and account for the majority of health care expenditures in this country. Despite efforts to enhance the quality of care delivered to chronically ill patients, studies continue to reveal tremendous variability in both practice and outcomes in this population. This study proposes to bring together a unique collaboration of physicians, employers, health plans, and payers from the private and public sector both regionally and nationally, to achieve a 'tipping point' in health care and, thereby, accelerate the rate at which improvement in the quality of care delivered in outpatients settings for a substantial portion of the chronically itt patient population in the U.S can occur. Specifically, the American Medical Association, Pittsburgh Regional Healthcare Initiative, Iowa Foundation for Medical Care, Blue Cross and Blue Shield Association, Centers for Medicare and Medicaid Services, and the Midwest Business Group on Health are cooperating in a partnership to identify the infrastructure necessary to make relevant data and clinical performance measurement tools available to physicians at the point of care for patients with diabetes, major depressive disorder, or coronary artery disease; to enable data collection, retrieval, and transfer within and across physician offices, health plans, and laboratories; to identify the perceived obstacles, burdens, as well as incentives for physicians and others who participate in efforts to improve the quality of care for patients with chronic diseases through the use of performance measurement; and to determine the feasibility of creating an integrated data registry that will enable the provision of benchmarking data to physicians and aggregate data to health plans and third party payors. The methods by which these aims will be achieved inctude adaptation and implementation of performance measurement sets developed by the Physician Consortium for Performance improvement for diabetes, major depressive disorder, and coronary artery disease in a select sample of primary care physician offices in two regions of the U.S.; on-site identification of data capabilities for physicians, health plans, and laboratories participating in the study; and evaluation of physician, plan, laboratory, and employer experience with measurement tools and data collection and delivery processes.