文章基本信息

标题：A Framework for Describing Health Care Delivery Organizations and Systems
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作者：Ileana L. Piña ; Perry D. Cohen ; David B. Larson 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2015
卷号：105
期号：4
页码：670-679
DOI：10.2105/AJPH.2014.301926
语种：English
出版社：American Public Health Association
摘要：Describing, evaluating, and conducting research on the questions raised by comparative effectiveness research and characterizing care delivery organizations of all kinds, from independent individual provider units to large integrated health systems, has become imperative. Recognizing this challenge, the Delivery Systems Committee, a subgroup of the Agency for Healthcare Research and Quality’s Effective Health Care Stakeholders Group, which represents a wide diversity of perspectives on health care, created a draft framework with domains and elements that may be useful in characterizing various sizes and types of care delivery organizations and may contribute to key outcomes of interest. The framework may serve as the door to further studies in areas in which clear definitions and descriptions are lacking. Recent and ongoing innovation in systems for the delivery and reimbursement of health care in the United States have broadened stakeholders’ need for standardized methods to describe, measure, compare, and evaluate delivery system changes. A common taxonomy of delivery system characteristics would allow for improved communication and transparency regarding these changes, potentially enhancing the quality of decisions and care for patients, providers, researchers, policymakers, payers, and other stakeholders. 1–5 The comparative effectiveness of delivery system characteristics is ranked as a top priority by the Institute of Medicine, which has defined comparative effectiveness research (CER) as “the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care.” 6 ^(p203) Yet, there is no standard way to describe care delivery units or systems that encompasses their breadth, ranging from independent individual provider units to large integrated health systems. 7 Thus, the absence of a common parlance for describing delivery systems hinders stakeholders from determining the generalizability of a study or an innovation introduced in 1 setting. The effectiveness of an intervention may be quite different depending on whether the setting is a large integrated care system or a small independent practice and whether providers are paid on production or salaried. We propose a preliminary framework for description of health care delivery systems that will allow health care stakeholders to better understand, evaluate, disseminate, and implement delivery system innovation in a more informed, transparent, and stakeholder-centered fashion and permit comparisons among them. Our objective is to present the domains and elements of the framework, the methods that were used to derive it, and examples of its potential application in diverse settings.