보건의료 "제3의 커브"에 있어서 대학의학의 중요한 역할 (Acad Med, 2016)

보건의료 "제3의 커브"에 있어서 대학의학의 중요한 역할 (Acad Med, 2016)

Academic Medicine’s Critical Role in the “Third Curve” of Health Care

Harold L. Paz, MD, MS

 

 

With more than two decades of experience leading academic health systems and practices, I have watched the world of academic medicine steadily evolve against the backdrop of an enormous and unprecedented structural transformation of U.S. health care.

From the public health movement in the early part of the 19th century,

• to the definition of health by the World Health Organization,2

• the rise of community-based medical schools,

• the conceptualization of the biopsychosocial model of health, and

• measurement of social determinants of health, all in the latter part of the 20th century,

the core elements of this transformation in our health system have been in place for years. The convergence of this work with new payment models distinct from fee-for- service medicine has brought us to a post-Flexner era of population health.

Plotting the Curve of the U.S. Health System

보건의료전달체계 모델은 하나의 모델이 널리 받아들여지면서 성장했다가, 다른 모델이 그 자리를 대체하면서 감소taper하는 양상을 띈다. 커브I (fee-for-service)로부터 커브II (population health)로 옮겨왔으며, 우리는 이제 커브III (소비자-주도 보건의료consumer-directed health care)에 이르렀다. 첫 두 개의 커브가 건강을 제공자와 사업의 관점에서 보는 것이라면, 세 번째 커브는 개개인을 curated health ecosystem의 중심으로 본다.

Health care delivery models can be seen as graphed curves that rise as they are widely adopted and then taper off as another model begins to take their place.3 As quickly as we have moved from Curve I (fee-for-service) to Curve II (population health), we are now crossing over to a new form of consumer-directed health care, or what I call the third curve of health care (Curve III). While the first two curves look at health from a provider and business perspective, the third curve places the individual in the center of a curated health ecosystem.

 

의사가 아니라 환자가 그들 스스로의 건강을 소유own하고 있다는 인식이 확산되면서, 새로운 자원과 도구가 각 개개인의 소유권을 더 강화시키게끔 해 주었고, care plan에 더욱 adhere하게, 그리고 자신의 웰-빙에 더 책임을 갖는다고 느끼게끔 해주었다. 우리는 이 새로운 도구와 자원을 포용해야 한다(모바일 어플, 원격의료, 가정의료, urgicare 센터, 기타 등등) 의사와 보건의료시스템은 양보다는 질에 더 관심을 두어야 하며reward, 신체의 건강이 행동적 건강과 사회적 건강과 상호의존적임을 설명할 수 있어야 한다.

Recognizing that patients, not physicians, own their health, new resources and tools will enable each individual to take more ownership, become more likely to adhere to care plans, and feel more empowered to take charge of his or her well-being. We must embrace these new tools and resources, such as mobile apps, telemedicine, home health, “urgicare” centers, and other technologies to improve the health of our patients. Physicians and health systems must be rewarded for quality over volume and must be able to address the interdependencies of behavioral and social health on physical well- being.

 

커브III는 인터넷이나 소셜미디어 등을 통한 경험에 의해서 형성되는 소비자의 기대의 모든 변화에 면역immune이 될 수 없다는 인식으로부터 만들어졌다. 의심할 여지 없이 모든 세 개의 커브가 한동안은 공존할 것이지만, 대규모 데이터와 유전체 분석과 건강정보 분석이 환자-중심의 의료로 갈 것을 보여주고 있으며 우리는 이제 고작 막 상상을 할 뿐이다.

Curve III is shaped by the recognition that health care is not immune to overall changes in consumer expectations driven by experiences with the Internet, social media, and information transparency in other sectors of the economy. Undoubtedly, all three curves will, for a time, coexist, but the convergence of large data sets and analytics with genomics and health information will certainly make good on the promise of patient- centered care in ways we can only begin to imagine.

적응하여 살아남을 수 있는 의사 기르기

Training Physicians Who Can Adapt and Thrive

미래의 의사는?

What will the physicians of the future look like, and how will they operate?

컴퓨터는 공감능력이 없고, 이는 academic medical institutions들이 기술에 의해 남겨진 영역인 인성과 스킬 세트를 개발시키는 것에 중점look for을 둬야 한다는 압박을 주고 있다.

Computers do not offer compassion, and this will increase the pressure on academic medical institutions to look for and develop the personality and skill sets necessary to fill the void left by technology.

의사를 양성함에 있어서 이들이 전문직으로 이뤄진 팀의 리더 역할을 할 수 있게 준비되어야 하며, 보건의료 데이터 분석과 기술을 접목하여 개개인의 건강과 웰니스 경험을 만들어줄 수 있어야 한다. 리더십의 특성(공감, 신뢰, 의사소통, 의지determination, 용기, 진실성, 비전)은 다른 분야와 다르지 않다.

there must be an emphasis on preparing physicians to serve as leaders of teams of professionals that create a health and wellness experience for individuals that combines health care with data analytics and technology. The attributes of leadership, including empathy, trust,  communication, determination, courage, integrity, and vision, are no different in medicine than in any other field.

협력은 우리를 미래로 이끄는 핵심이다. 환자-의사 관계가 유지되기 위해서는 의사는 반드시 가능한 최대한 리더로서 역할을 할 수 있게 훈련되어야 한다.

Collaboration will be the key to leading us into the future. If the doctor–patient relationship is to be preserved, physicians must be trained to serve as leaders to the greatest extent possible.

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Acad Med. 2016 May;91(5):613-4. doi: 10.1097/ACM.0000000000001165.

Academic Medicine's Critical Role in the "Third Curve" of Health Care.

Paz HL1.

Author information

• 1H.L. Paz is executive vice president and chief medical officer, Aetna, Hartford, Connecticut, and professor adjunct of internal medicine, Yale University School of Medicine, New Haven, Connecticut.

Abstract

Over the last several years, the health care landscape has changed at an unprecedented rate due to new economic and regulatory forces ushered in by the Affordable Care Act and the introduction of innovative technologies, such as personalized medicine, that are poised to open the door to consumer-driven health care. Tremendous pressure exists on academic health centers to rapidly evolve clinically while not abandoning their uniqueacademic mission. The convergence of personalized medicine, new digital technologies, and changes in health professionals' scope of practice alongside new payment structures will accelerate the move to a patient-centered health system. In this Commentary, the author argues that these new tools and resources must be embraced to improve the health of patients. With the traditional, fee-for-service model of care as "Curve I" and the post-Flexner era of population-based medicine as "Curve II," the author identifies the emergence of "Curve III," which is characterized by patient-centered, consumer-directed models of care. As the old models of health care undergo transition and the impact of technology and analytics grow, future practitioners must be trained to embrace this change and function effectively in the "third curve" of consumer-driven health care.

PMID:

 

27008361

 

[PubMed - in process]