构建连续护理模式：来自艾滋病毒、丙型肝炎病毒、结核病的经验教训及对改进护理与预防连续模式发展的启示
Conceptualizing Care Continua: Lessons from HIV, Hepatitis C Virus, Tuberculosis and Implications for the Development of Improved Care and Prevention Continua.
作者信息
Perlman David C, Jordan Ashly E, Nash Denis
机构信息
Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA; Center for Drug Use and HIV Research, New York, NY, USA.
Department of Epidemiology, School of Public Health, City University of New York, New York, NY, USA; Center for Drug Use and HIV Research, New York, NY, USA.
出版信息
Front Public Health. 2017 Jan 10;4:296. doi: 10.3389/fpubh.2016.00296. eCollection 2016.
BACKGROUND
To examine the application of continuum models to tuberculosis, HIV, and other conditions; to theorize the concept of continua; and to learn lessons that could inform the development of improved care and prevention continua as public health metrics.
METHODS
An analytic review of literature drawn from several fields of health care.
RESULTS
The continuum construct is now part of public health evaluation systems for HIV, and is increasingly used in public health and the medical literature. Issues with the comparability and optimal design of care continuum models have been raised, and their methodologic and theoretic underpinnings and scope of focus have been under-addressed. Review of relevant publications suggests that a key limitation of current models is their lack of measures reflecting incidence and mortality. Issues relating to continua data being longitudinal or cross-sectional, definition of numerators and denominators for each step, data sources, measures of timeliness of step completion, theoretic models to facilitate inferences of causes of care continuum gaps, how measures of prevention efforts, reinfection/relapses, and interactions of continua for co-occurring comorbidities should be reflected, and how analyses of differences in retention over time, across geographic regions, and in response to interventions should be conducted are critical to the development of sound care and prevention continuum models.
CONCLUSION
Lessons learned from the application of continuum models to HIV and other conditions suggest that the application of well-formulated constructs of care and prevention continua, that depict, in well defined, standardized steps, incidence and mortality, along with degrees of and time to screening, engagement in care and prevention, treatment and treatment outcomes, including relapse or reinfection, may be vital tools in evaluating intervention and program outcomes, and in improving population health and population health metrics for a wide range conditions.
背景
探讨连续统模型在结核病、艾滋病病毒及其他病症中的应用；对连续统概念进行理论化；汲取经验教训，为完善作为公共卫生指标的照护与预防连续统的发展提供参考。
方法
对来自医疗保健多个领域的文献进行分析性综述。
结果
连续统构建现已成为艾滋病病毒公共卫生评估系统的一部分，并在公共卫生和医学文献中越来越多地被使用。有人提出了照护连续统模型的可比性和优化设计问题，而其方法学和理论基础以及关注范围尚未得到充分探讨。对相关出版物的回顾表明，当前模型的一个关键局限性在于缺乏反映发病率和死亡率的指标。与连续统数据是纵向还是横断面数据、每一步骤分子和分母的定义、数据来源、步骤完成及时性的衡量指标、有助于推断照护连续统差距原因的理论模型、应如何反映预防努力、再感染/复发以及共病连续统相互作用的指标，以及应如何进行不同时间、不同地理区域以及对干预措施反应的留存率差异分析等问题，对于完善的照护和预防连续统模型的发展至关重要。
结论
从连续统模型在艾滋病病毒及其他病症中的应用中汲取的经验教训表明，应用精心制定的照护和预防连续统构建，以明确、标准化的步骤描绘发病率、死亡率，以及筛查程度、参与照护和预防的时间、治疗及治疗结果，包括复发或再感染，可能是评估干预措施和项目结果、改善广泛病症人群健康及人群健康指标的重要工具。
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