美国建筑师协会会士、美国医疗建筑学院主席美国德克萨斯A M大学健康系统与设计研究中心主任建筑学院教授A.雷•潘迪考斯特：美国医疗设计发展趋势

shapethefutureofealthcareshapethefutureofealthcareA.RayPentecostIIIDrPH,FAIA,FACHA,LEEDAPRonaldL.SkaggsandJosephG.SpragueChairofHealthFacilitiesDesignDirector,CenterforHealthSystems&DesignCollegeofArchitectureSchoolofPublicHealthTexasA&MUniversityCenterCenterforHealthSystems&DesignTexasA&MUniversityThechallengeeshealthcaresystemdCenterforHealthSystems&DesignTexasA&MUniversityQ1Patient:Helporhindranceinhealthcarereform?CenterCenterforHealthSystems&DesignTexasA&MUniversityPatientChronicDisease•81%Hospitaladmissions•76%Physicianvisits•91%PrescriptionsCDCFoundation2015CenterCenterforHealthSystems&DesignTexasA&MUniversityPatientDonttellme!50%Average70%(!)IfchangebehaviorStoryDr.Rick125,000Deathsfromtreatableconditions23%Nursinghomeadmissions10%HospitaladmissionsCenterCenterforHealthSystems&DesignTexasA&MUniversityQ2Informationtechnologies:Areweforeverbehindthecurve?CenterCenterforHealthSystems&DesignTexasA&MUniversityInformationCpatients Watsonidentifiedatreatmentthatawell-meaning,hard-workinggroupofphysicianshadn’tfound–for30%ofthepatients!NedSharpless,MD,UNCChappelHillRose,Charlie.(2016).ReportTitle(Artificialintelligencepositionedbebeagame-changer).CBSInteractive,60Minutes.NewYork,NY.CenterCenterforHealthSystems&DesignTexasA&MUniversityDoublingUp:umRenewalProjectUniversityofIowahealthcareCenterCenterforHealthSystems&DesignTexasA&MUniversityCenterforHealthSystems&DesignTexasA&MUniversityQ3Nextgenerationhealthcarefacilities:Whenisflexibilitynotenough?CenterCenterforHealthSystems&DesignTexasA&MUniversityDesignReality:LowerPaymentforCareRequiresceHoustonTXNovemberCenterCenterforHealthSystems&DesignTexasA&MUniversityDesignReality:Out-of-DateFacilitiesdon’thouseNewModelsofCare:•“Retail-ization”ceHoustonTXNovemberCenterCenterforHealthSystems&DesignTexasA&MUniversityDesignechnologyMovingPatientsAwayFrom“Traditional”Facilities:ceHoustonTXNovemberCenterforHealthSystems&DesignTexasA&MUniversityVirtualpatientexperiences:CenterCenterforHealthSystems&DesignTexasA&MUniversityVirtualKaiserPermanentepatientexperiencesCenterCenterforHealthSystems&DesignTexasA&MUniversityVirtual•47.5%fewerunnecessaryERreferralsinIsraeltheEHealthSuccessStorytechnologyunderrnationalAcademyforDesignHealthHelsinki,Finland,September20,2012.CenterCenterforHealthSystems&DesignTexasA&MUniversityVirtualLuminox:asuccessstoryDropoutrate40%after3monthsCenterCenterforHealthSystems&DesignTexasA&MUniversityQ5Demandsignal:ComingfromclinicalservicesorIT?CenterCenterforHealthSystems&DesignTexasA&MUniversityDemandInthe2030s,wearegoingtosendnano-robotsintothebrain(viacapillaries)thatwillprovidefullimmersionvirtualrealityfromwithinthenervoussystemandwillconnectourneocortextothecloud.larityHubOctCenterCenterforHealthSystems&DesignTexasA&MUniversityDemandAssoonasthe2040s,itispossiblethathumanswillbe“predominantlynon-biological.Andthenon-biologicalpartwillbesosmartitwillfullyunderstandandbeabletomodelandsimulatethebiologicalpart.”CenterforHealthSystems&DesignTexasA&MUniversityQ6Risinghealthcarecosts:Dowehavethewilltosetlimits?CenterCenterforHealthSystems&DesignTexasA&MUniversityCostOtherEconomicSpendingas%GDPOtherEconomicSpendingas%GDPDPtrnanceandtionCenterCenterforHealthSystems&DesignTexasA&MUniversitySpending:nationalsecurityervicesOfficeoftheudeimpactsoftheAffordableCareActCenterCenterforHealthSystems&DesignTexasA&MUniversityAndfinally…rpentecost@+1-979-845-7877CenterCenterforHealthSystems&DesignTexasA&MUniversityCostStoryFord(up12%/1year)2Sep.14,2016.2ChrisLange,MostAmericansCan’tAffordCommonUnexpectedExpenses,24/7,Jan.12,2017CenterforHealthSystems&DesignTexasA&MUniversityVirtualGeneRoddenberry,andCenterforHealthSystems&DesignTexasA&MUniversity For74,000patients65+yearsFewerhospitalizations/month258(-3.49pats/mo)Fewerhospitalizationdays/yearHospitalcostperdayTotalsavings/yearTotalcost/yearNetsavings/yearReturnonInvestment357%YossiBahagon,MD,Israel,HealthInfrastructureinIsrael:theE-HealthSuccessStory,technologyunderdevelopmentbyClalitHealthsystem,Design&HealthEurope,2012,InternationalAcademyforDesign&Health,Helsinki,Finland,September20,2012.CenterCenterforHealthSystems&DesignTexasA&MUniversity OfficewithaWiigame!Considerhomemedicaldevicesystems:•Emergencycall•Falldetection•GPSnotification•Portable–cantravelwithyouCenterCenterforHealthSystems&DesignTexasA&MUniversity4.PopulationHealthMandatesRequireEvaluationofEffectofEnvironmentonHealth:üSocial/SocietalüAir/Water/FoodüLifestyleEnvironmentAfects10%ofHealth**SummaryofDifferentPerspectivesonAssigningWeightstoDeterminantsofHealth,CountyHealth VirtualCare:PatientExperienceFrontiersConnectivity(withinandoutside)FinancialProductivity(improvedefficiency,ROI)PatientAccountability(keytosuccess)TechnologyInnovationRe-purposingfacilitiesCenterCenterforHealthSystems&DesignTexasA&MUniversity MajorUSHealthcareSystemNewConstruction0%Newfocus:“AssetLifeExtension”Why?1)Preservationofcapital2)Migrationawayfromfacilities-basedthinkingCenterCenterforHealthSystems&DesignTexasA&MUniversitystRegulatoryBurdenCapitalInvestmentResourceIntensitytoImplementLengthoftoImplementCenterCenterforHealthSystems&DesignTexasA&MUniversity1.DecliningReimbursementDrivingNeedforMoreEfficientUseofCapital2.TechnologyMovingPatientsAwayFrom“Traditional”Facilities3.NewModelsofCareCannotBeDeliveredEfficientlyinOut-of-DateFacilities4.PopulationHealthMandatesRequireEvaluationofEffectofEnvironmentonHealth5.NewConsumer“Mindset”CenterCenterforHealthSystems&DesignTexasA&MUniversityPatientWhoknew?33%marginalliteracy42%medsconfusion25%follow-upconfusion60%informedconsent?CenterCenterforHealthSystems&DesignTexasA&MUniversityPatientSummaryofthekeychangeagent:•Misguided•Unhealthy•Disrespectful•Uninformed•AddictedANDDemandingCenterforHealthSystems&DesignTexasA&MUniversityPatientNew“Mindset”ofConsumer:•IWantConvenience•IWanttheLowestPrice•Icareaboutthebrand(ImpliedQuality)•IDon’tWanttoWait•IWantaPleasantEnvironment•IWantChoice•IWanttoBuyfromMySmartphoneceHoustonTXNovemberCenterCenterforHealthSystems&DesignTexasA&MUniversityQ5Designingforpopulationhealth:Isitmorethanhospitalsandclinics?CenterCenterforHealthSystems&DesignTexasA&MUniversityPatientAttituder•Whatever:don’taskmetobeinvolved.CenterCenterforHealthSystems&DesignTexasA&MUniversityPatientIt’stheotherwhitepowderDeathsfromillicitdrugs:(cocaine,heroin)Deathsfromobesity:nesugarNIDA2015CenterforHealthSystems&DesignTexasA&MUniversityInformationIBM90Jeopardy1,000,000b/secRose,Charlie.(2016).ReportTitle(Artificialintelligencepositionedbebeagame-changer).CBSInteractive,60Minutes.NewYork,NY.CenterCenterforHealthSystems&DesignTexasA&MUniversityVirtualClinical trialsJune,2014inIsraeltheEHealthSuccessStorytechnologyunderrnationalAcademyforDesignHealthHelsinki,Finland,September20,2012.CenterforHealthSystems&DesignTexasA&MUniversityPopulationhealth“Thefunctionofgnfor“Thefunctionof healthmustrankevenaboveimpaired.”OTECTthDesigntoDEVELOPthOREth