Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N Wolfe Street #2055, Rubenstein Building, Baltimore, MD, 21287, USA,
Matern Child Health J. 2014 Feb;18(2):389-95. doi: 10.1007/s10995-013-1279-9.
Life Course Theory (LCT) is a framework that explains health and disease across populations and over time and in a powerful way, conceptualizes health and health disparities to guide improvements. It suggests a need to change priorities and paradigms in our healthcare delivery system. In "Rethinking Maternal and Child Health: The Life Course Model as an Organizing Framework," Fine and Kotelchuck identify three areas of rethinking that have relevance to clinical care: (1) recognition of context and the "whole-person, whole-family, whole-community systems approach;" (2) longitudinal approach with "greater emphasis on early ("upstream") determinants of health"; and (3) need for integration and "developing integrated, multi-sector service systems that become lifelong "pipelines" for healthy development". This paper discusses promising clinical practice innovations in these three areas: addressing social influences on health in clinical practice, longitudinal and vertical integration of clinical services and horizontal integration with community services and resources. In addition, barriers and facilitators to implementation are reviewed.
生命历程理论(LCT)是一个解释人口和时间跨度内健康和疾病的框架,以一种强大的方式概念化健康和健康差距,以指导改进。它建议需要改变我们的医疗保健提供系统的优先事项和范式。在“重新思考母婴健康:生命历程模型作为组织框架”中,Fine 和 Kotelchuck 确定了与临床护理相关的三个重新思考领域:(1)对背景和“全人、全家庭、全社区系统方法”的认识;(2)具有“更强调健康的早期(上游)决定因素”的纵向方法;以及(3)需要整合和“开发综合的、多部门服务系统,成为健康发展的终身‘管道’”。本文讨论了这三个领域中具有前景的临床实践创新:在临床实践中解决健康的社会影响、临床服务的纵向和垂直整合以及与社区服务和资源的水平整合。此外,还回顾了实施的障碍和促进因素。