Donabedian A
Department of Health Services Management & Policy, School of Public Health, University of Michigan, Ann Arbor 48109.
Milbank Q. 1989;67(2):233-56; discussion 257-67.
E.A. Codman's conception and development of the "end result idea" in the 1910s are unduly neglected in the history of health care assessment. The "idea" entailed following patients long enough to determine if treatments proved successful and taking comprehensive measures to prevent new failures if outcomes were undesirable. Codman's work anticipated contemporary approaches to quality monitoring and assurance, establishing accountability, and allocating and managing resources efficiently, among other assessment features. Complexity and ambiguity in health care objectives, decision making, and role responsibilities as well as costs today hinder full application of his vision, but refinement of these factors proceeds in the directions Codman set forth.
20世纪10年代，E.A. 科德曼对“最终结果理念”的构想与发展，在医疗保健评估史上未得到应有的重视。该“理念”要求对患者进行足够长时间的跟踪，以确定治疗是否成功，并在结果不理想时采取全面措施防止新的失败。科德曼的工作预见了当代质量监测与保证、建立问责制以及有效分配和管理资源等评估方法，以及其他评估特征。当今医疗保健目标、决策、角色责任以及成本方面的复杂性和模糊性阻碍了他的愿景的全面应用，但这些因素的改进正朝着科德曼所设定的方向发展。
