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1、ThisframeworkpaperisSupplementaryAppendix1toPorterME.Whatisvalueinhealthcare?NEnglJMed2010;363:2477-81(10.1056/NEJMp1011024).VALUEINHEALTHCAREMichaelE.Porter,Ph.D.Inanyfield,improvingperformanceandaccountabilitydependsonhavingasharedgoalthatunitestheinterestsandactivitiesofallstakeholders.Inmostfi
2、elds,thepreeminentgoalisvalue.Theconceptofvaluereferstotheoutputachievedrelativetothecostincurred.Definingandmeasuringvalueisessentialtounderstandingtheperformanceofanyorganizationanddrivingcontinuousimprovement.Inhealthcare,valueisdefinedasthepatienthealthoutcomesachievedperdollarspent.Valueshoul
3、dbethepreeminentgoalinthehealthcaresystem,becauseitiswhat1ultimatelymattersforcustomers(patients)andunitestheinterestsofallsystemactors.Ifvalueimproves,patients,payers,providers,andsupplierscanallbenefitwhiletheeconomicsustainabilityofthehealthcaresystemimproves.Valueencompassesmanyoftheothergoals
4、alreadyembracedinhealthcare,suchasquality,safety,patientcenteredness,andcostcontainment,andintegratesthem.Itisalsofundamentaltoachievingotherimportantgoalssuchasimprovingequityandexpandingaccessatreasonablecost.Despitetheoverarchingsignificanceofvalueinhealthcare,however,ithasnotbeenthecentralfocu
5、s.Indeed,valueremainslargelyunmeasurednotonlyintheUnitedStatesbutaroundtheworld,perpetuatinghealthcaredeliveryasanartandnotascienceamenabletocontinuousimprovement.(Valuemustbemeasureddirectlyinhealthcarebecauseprofitability,theproxyforvalueinmostindustries,isnotareliableindicatorofvalueinhealthcar
6、ebecauseofflawedreimbursementandlackofcompetitionbasedonactualresults.)Insteadofvalue,healthcarestakeholdershavemyriad,oftenconflictinggoals,includingaccesstoservices,profitability,highquality,costcontainment,safety,convenience,andpatientsatisfaction.Quality,acrucialconceptforhealthcareimprovement
7、,isusedinsomanywaysastohavelostitsmeaningandusefulness.TheInstituteofMedicine’sowndefinitionofgoalsforthehealthcaredeliverysystemincludesnolessthansixdisparateelements:safety,effectiveness,patientcenteredness,2ti
