Starfield Summit: Developing a National Strategic Vision for Primary Care

项目摘要 背景：美国医疗保健系统需要足够的质量措施来完成评估、评估、 并促进初级保健领域的持续改进。政策制定者和医疗保健领导者 呼吁减少适用于初级卫生保健的质量措施的数量。减少了 使用的初级保健措施的数量将减少与测量相关的行政负担 报道。然而，由于重点是适应当前的措施，而不是重新设计，这些努力未能 解决我们当前测量系统特有的挑战。这些挑战包括：近视 注重特定疾病的临床过程和结果；根据政策和需求采取措施 付款，而不是通过健康和治疗主动通知；歪曲和低估 初级卫生保健的贡献；对患者重要的健康结果与那些 正在衡量的项目；以及对于我们应该衡量什么以及为什么衡量缺乏统一的愿景。1978年， 世界卫生组织(WHO)阿拉木图会议确定，强有力的初级卫生保健是 是任何高性能医疗保健系统的基础。芭芭拉·斯塔菲尔德1994年的钥匙鉴定 初级保健的属性--首次接触、基于关系的连续性、全人全面护理和 协调--被全球公认为标准。尽管对功能有明确的定义和协议 和初级保健的属性，我们定义和识别初级保健质量的能力仍然难以捉摸。 目的：在利益相关者知情的情况下制定初级保健质量的操作定义；确定 能够指导制定有意义的初级保健措施的概念框架；确定关键 缺乏质量指标的初级保健的属性和职能；并制定战略计划 制定有意义的措施，可在明年内采取行动。 方法：我们将把初级保健利益相关者和领导者的独特组合聚集在一起，形成三个- 一天的会议，包括大小组讨论和小小组讨论。发布简报，设计在五个左右 基本问题将定义每个问题，描述其重要性，并提供最佳证据的项目符号说明 到目前为止，并建议小组讨论的重点领域。这五个问题是：1)什么是小学质量 关注，2)测量它的目的是什么，3)从现在开始五年后测量的最佳实践是什么 看起来是这样的，4)有什么机会可以或将创造什么机会来实现我们的目标，以及5)谁需要 我们解决方案社区的一部分。 好处：改变优质初级保健措施的结构是可能的，也是成功的必要的 振兴美国初级保健系统。这次会议将是利益相关者领导的第一次努力，以创建一个 能够评估和向国家报告初级保健价值的概念框架和统一愿景 实现三重目标：改善人口健康、改善患者体验和更明智的支出。

Project Summary Background: The US Health Care System needs quality measures adequate to the task of assessing, valuing, and fostering continuous improvement within the fields of primary care. Policymakers and health care leaders have called for a reduction in the number of quality measures applied to primary health care. Reducing the number of primary care measures used will reduce administrative burden associated with measurement reporting. However, with a focus on adaption of current measures rather than redesign, these efforts fail to address the challenges endemic to our current measurement system. These challenges include: a myopic focus on disease-specific clinical processes and outcomes; measures reactive to the needs of policy and payment rather than proactively informed by health and healing; misrepresentation and underrepresentation of primary health care's contributions; a disconnect between health outcomes important to patients and those items being measured; and absence of a unified vision regarding what we should measure and why. In 1978, the World Health Organization (WHO) Alma-Ata conference established that robust primary health care is foundational to any high performing health care system. Barbara Starfield's 1994 identification of the key attributes of primary care – first contact, relationship-based continuity, whole person comprehensive care, and coordination – is globally accepted as standard. Despite clear definition and agreement regarding the function and attributes of primary care, our ability to define and identify quality in primary care remains elusive. Purpose: To develop a stakeholder informed operational definition for quality in primary care; to define a conceptual framework able to guide development of meaningful primary care measures; to identify key attributes and functions of primary care in which quality indicators are lacking; and to create a strategic plan for the development of meaningful measures actionable within the next year. Methods: We will bring together a unique combination of primary care stakeholders and leaders for a three- day conference that incorporates both large and small group discussion. Issue Briefs, designed around five basic questions will define each question, describe its importance, provide a bulleted account of best evidence to date, and suggest focused areas for group discussion. The five questions are: 1) what is quality in primary care, 2) what is the purpose of measuring it, 3) what would best practice for measurement five years from now look like, 4) what are the opportunities available or to be created for getting us there, and 5) who needs to be part of our community of solution. Benefit: Shifting the structure of quality primary care measures is possible and necessary for the successful revitalization of the US primary care system. This conference will be the first stakeholder-led effort to create a conceptual framework and unified vision able to assess and report the value of primary care to the national achievement of the Triple Aim: improved population health, better patient experience, and smarter spending.