Wasson J, Keller A, Rubenstein L, Hays R, Nelson E, Johnson D
Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Hanover, NH.
Med Care. 1992 May;30(5 Suppl):MS42-9. doi: 10.1097/00005650-199205001-00004.
In the past decade physicians have identified the need to expand patient assessment to include global function and quality of life. During the same period, the busy clinic has evolved into the location where this assessment seems most appropriate. Integrating functional health assessment into a busy clinical practice is difficult because the necessary steps require time, thought, recording, and follow-up. Attention to the office ecosystem is very important before any patient care management method is introduced. The clinician must transform the results of health status screening into a specific functional diagnosis. The clinician has to understand the sensitivity, specificity, and predictive value of the measure for a preliminary diagnosis to be made. Often, additional measurements must be taken to establish a specific diagnosis. These steps encompass assessment linkage. Once the specific cause for the dysfunction is recognized, the clinician then has to determine the need for special resources. This is called the resource linkage. By following the steps outlined in this paper, the clinician should be able to overcome many obstacles for functional health status assessment in busy ambulatory settings.
在过去十年中，医生们已经认识到有必要扩大患者评估范围，将整体功能和生活质量纳入其中。在同一时期，繁忙的诊所已演变成进行这种评估似乎最为合适的场所。将功能健康评估融入繁忙的临床实践很困难，因为必要步骤需要时间、思考、记录和随访。在引入任何患者护理管理方法之前，关注办公室生态系统非常重要。临床医生必须将健康状况筛查结果转化为具体的功能诊断。临床医生必须了解该测量方法对于初步诊断的敏感性、特异性和预测价值。通常，必须进行额外测量以确立具体诊断。这些步骤包含评估关联。一旦识别出功能障碍的具体原因，临床医生就必须确定是否需要特殊资源。这称为资源关联。通过遵循本文所述步骤，临床医生应该能够克服繁忙门诊环境中功能健康状况评估的许多障碍。
