美国腹膜透析激励政策的经验及对我国的启示

The experience of American peritoneal dialysis favored policy and its enlightenment to China

目的:梳理美国腹膜透析激励政策(peritoneal dialysis favored policy,PD-Favored)的实施背景和发展历程,为我国居家腹膜透析治疗模式的推广提供经验借鉴。方法:基于文献分析法,系统总结美国实施PD-Favored政策的主要措施和特点。结果:美国PD-Favored政策主要通过以下四类措施影响供需双方行为:建立前瞻性捆绑支付模式以引导医疗机构提供腹膜透析;通过按人头付费提高医生提供腹膜透析的积极性;通过设立等待期、限制频繁透析和实施治疗选择教育计划引导患者采用腹膜透析;实施质量激励计划以及推动腹膜透析治疗技术创新。结论:美国PD-Favored政策通过医保支付、政府调控等手段影响供需双方的行为,有效促进腹膜透析的普及。未来我国在推广居家腹膜透析模式的过程中应重在完善医保支付政策,采用多学科方法对患者进行透析前教育,并加强医护人员培训,在确定技术规范基础上确定中国腹膜透析质量管理目标。

Objective:To study the policies of peritoneal dialysis favored policy(PD-Favored)in the United States,sort out its background and development process,and then provide experience for China to promote home peritoneal dialysis.Methods:The study systematically summarized the measures and features of PD-Favored policy in the United States based on scoping review.Results:PD-Favored policy in the United States mainly influence the behaviors of supply and demand through the following four measures:establish the End Stage Renal Disease Prospective Payment System;Increase physicians’motivation to provide peritoneal dialysis by establishing the monthly capitated payment;guide patient to adopt peritoneal dialysis by establishing waiting periods,limiting frequent dialysis and implementing treatment options education program;implement quality incentive programs and promote technological innovation in peritoneal dialysis treatments.Conclusions:PD-Favored policy in the United States has influenced the behaviors of supply and demand through medical insurance payment and government regulation.It has effectively promoted the popularity of peritoneal dialysis.In the future,to promote home peritoneal dialysis,China should improve its medical insurance payment policy,adopt a multidisciplinary approach to pre-dialysis education for patients and strengthen the training of medical staff,set up the quality management target of Chinese peritoneal dialysis based on the technical specifications.