Sofaer Shoshanna
Baruch College.
Med Care Res Rev. 2009 Feb;66(1 Suppl):75S-93S. doi: 10.1177/1077558708327945. Epub 2008 Dec 12.
American health care is complex, fragmented, and arcane rather than being patient centered. Many patients have considerable difficulty navigating this system. As a result, care is less timely, safe, effective, and efficient. Since navigation problems are more likely for those who are sicker and less educated, they contribute to inequity. Early solutions proposed for this problem focused on the use of yet another specialized professional, the "navigator," to help individuals find their way through the system so they get the care they need. The author defines the patient navigation problem and its probable consequences and argues that research and action are needed to (a) document the problem empirically, (b) identify underlying organizational structures and behaviors that can make navigation easy or difficult, and (c) assess whether and how policies, regulations, and improvement strategies can influence these structures and behaviors.
美国的医疗保健体系复杂、分散且晦涩难懂，而非以患者为中心。许多患者在应对这个体系时遇到了相当大的困难。结果，医疗服务的及时性、安全性、有效性和效率都有所降低。由于病情较重和受教育程度较低的人更有可能遇到就医指导问题，这些问题加剧了医疗不平等。针对这一问题早期提出的解决方案聚焦于引入另一种专业人员，即“就医指导人员”，来帮助个人在医疗体系中找到方向，从而获得所需的医疗服务。作者定义了患者就医指导问题及其可能产生的后果，并认为需要开展研究和采取行动，以便（a）通过实证记录该问题，（b）识别那些会使就医指导变得容易或困难的潜在组织结构和行为，以及（c）评估政策、法规和改进策略能否以及如何影响这些结构和行为。
