结合医疗整合与人群健康方法：重新设计策略与干预措施及其影响的范围综述
Combining Integration of Care and a Population Health Approach: A Scoping Review of Redesign Strategies and Interventions, and their Impact.
作者信息
Farmanova Elina, Baker G Ross, Cohen Deborah
机构信息
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, CA.
School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, CA.
出版信息
Int J Integr Care. 2019 Apr 11;19(2):5. doi: 10.5334/ijic.4197.
BACKGROUND AND AIM
Many health systems attempt to develop integrated and population health-oriented systems of care, but knowledge of strategies and interventions to support this effort is lacking. We aimed to identify specific redesign strategies and interventions, and to present evidence of their effectiveness.
METHOD
A modified scoping review process was carried out. Fifteen relevant examples of integrated care organizations that incorporated a broad population health approach in countries of the Organization for Economic Cooperation and Development described in 57 articles and reports were included in analysis.
RESULTS
Seven key redesign strategies and multiple redesign interventions have been identified and are described. Most commonly used redesign strategies included focusing on health and wellness, embracing intersectoral action and partnerships, addressing health in vulnerable groups, and addressing a wide range of determinants of health, including making improvements in health services. Redesign interventions included creative and innovative ways of addressing clinical and non-clinical issues such as establishing housing surgeries in primary care, establlishing vast social and provider networks to support patients with complex needs and also broadening of the scope of services, workforce redesign and other. Potential reductions in the utilization of care and costs could be derived by the wider adoption of these strategies and interventions.
CONCLUSION
Development of integrated and population health-oriented systems of care requires the redesign of how services are organized and delivered, and how organizations and care systems operate. Combining integration of care with the population health approach can be supported by a set of cohesive strategies and interventions aimed at preventing disease, addressing social determinants of health and improving health equity at both population- and individual-level.
背景与目的
许多卫生系统试图建立综合的、以人群健康为导向的照护体系，但缺乏支持这一努力的策略和干预措施的相关知识。我们旨在确定具体的重新设计策略和干预措施，并展示其有效性的证据。
方法
开展了一个经过修改的范围综述过程。分析纳入了57篇文章和报告中描述的经济合作与发展组织国家15个采用广泛人群健康方法的综合照护组织的相关实例。
结果
已确定并描述了七种关键的重新设计策略和多种重新设计干预措施。最常用的重新设计策略包括关注健康与福祉、接纳跨部门行动与伙伴关系、解决弱势群体的健康问题以及应对广泛的健康决定因素，包括改善卫生服务。重新设计干预措施包括以创新方式解决临床和非临床问题，如在初级保健中设立住房诊疗室、建立庞大的社会和提供者网络以支持有复杂需求的患者，以及扩大服务范围、重新设计劳动力等。更广泛地采用这些策略和干预措施可能会降低医疗服务利用率和成本。
结论
建立综合的、以人群健康为导向的照护体系需要重新设计服务的组织和提供方式，以及组织和照护系统运营的方式。将照护整合与人群健康方法相结合可以通过一套旨在预防疾病、解决健康的社会决定因素以及在人群和个体层面改善健康公平性的连贯策略和干预措施来实现。
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