Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York 10029-6574, USA.
J Palliat Med. 2013 Jul;16(7):730-3. doi: 10.1089/jpm.2013.9498. Epub 2013 May 29.
The U.S. health care system is struggling to improve the quality of health care while containing costs. The rapidly expanding population of older adults with serious illness presents both the greatest challenge and potentially the greatest opportunity to achieving this goal. In order to capitalize on this opportunity, we must first examine the epidemiology of the care of older adults with serious illness, that is, a full description of the characteristics and quality of care from the time of diagnosis through the full course of illness, including measurement of all factors that may influence or impact that care. Several methodological challenges exist in this area of study, including but not limited to, defining the onset of serious illness, avoiding bias in sample selection, and measuring the full breadth of personal, social, local, regional and provider factors that may influence care. Yet, this work is possible through a combination of targeted primary research and efficient leveraging of ongoing studies and existing data sources. Through these studies, we may identify those factors and services associated with high value health care, and learn to develop and refine policies and health care delivery models that yield the greatest improvements in care for seriously ill older patients and their families.
美国的医疗保健体系在努力提高医疗保健质量的同时控制成本。快速增长的患有重病的老年人口既是实现这一目标的最大挑战，也可能是最大的机遇。为了利用这一机会，我们必须首先检查患有重病的老年人护理的流行病学，即从诊断到整个疾病过程中对护理的特征和质量进行全面描述，包括衡量可能影响或影响护理的所有因素。在这一研究领域存在一些方法学挑战，包括但不限于定义严重疾病的发作、避免在样本选择中出现偏差，以及衡量可能影响护理的个人、社会、当地、区域和提供者因素的全部广度。然而，通过有针对性的基础研究和有效地利用正在进行的研究和现有数据源，这是可行的。通过这些研究，我们可以确定与高价值医疗保健相关的因素和服务，并学习制定和完善政策和医疗服务提供模式，为重病老年患者及其家属带来最大的改善。
