Croft Peter, Altman Douglas G, Deeks Jonathan J, Dunn Kate M, Hay Alastair D, Hemingway Harry, LeResche Linda, Peat George, Perel Pablo, Petersen Steffen E, Riley Richard D, Roberts Ian, Sharpe Michael, Stevens Richard J, Van Der Windt Danielle A, Von Korff Michael, Timmis Adam
Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele ST5 5BG, Staffordshire, UK.
BMC Med. 2015 Jan 30;13:20. doi: 10.1186/s12916-014-0265-4.
Diagnosis is the traditional basis for decision-making in clinical practice. Evidence is often lacking about future benefits and harms of these decisions for patients diagnosed with and without disease. We propose that a model of clinical practice focused on patient prognosis and predicting the likelihood of future outcomes may be more useful.
Disease diagnosis can provide crucial information for clinical decisions that influence outcome in serious acute illness. However, the central role of diagnosis in clinical practice is challenged by evidence that it does not always benefit patients and that factors other than disease are important in determining patient outcome. The concept of disease as a dichotomous 'yes' or 'no' is challenged by the frequent use of diagnostic indicators with continuous distributions, such as blood sugar, which are better understood as contributing information about the probability of a patient's future outcome. Moreover, many illnesses, such as chronic fatigue, cannot usefully be labelled from a disease-diagnosis perspective. In such cases, a prognostic model provides an alternative framework for clinical practice that extends beyond disease and diagnosis and incorporates a wide range of information to predict future patient outcomes and to guide decisions to improve them. Such information embraces non-disease factors and genetic and other biomarkers which influence outcome.
Patient prognosis can provide the framework for modern clinical practice to integrate information from the expanding biological, social, and clinical database for more effective and efficient care.
诊断是临床实践中传统的决策依据。对于已确诊和未确诊疾病的患者，这些决策未来的益处和危害往往缺乏证据。我们认为，一种关注患者预后并预测未来结果可能性的临床实践模式可能更有用。
疾病诊断可为影响严重急性疾病预后的临床决策提供关键信息。然而，诊断在临床实践中的核心作用受到了以下证据的挑战：它并不总是使患者受益，且疾病以外的因素在决定患者预后方面也很重要。疾病作为“是”或“否”的二分概念受到了频繁使用具有连续分布的诊断指标（如血糖）的挑战，血糖更好地被理解为提供有关患者未来结果概率的信息。此外，许多疾病，如慢性疲劳，从疾病诊断的角度无法有效地进行分类。在这种情况下，预后模型为临床实践提供了一个替代框架，该框架超越了疾病和诊断，纳入了广泛的信息来预测患者未来的结果并指导改善这些结果的决策。此类信息包括影响预后的非疾病因素、基因和其他生物标志物。
患者预后可为现代临床实践提供框架，以便整合来自不断扩展的生物学、社会和临床数据库的信息，实现更有效和高效的护理。
