The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA; National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD, USA.
National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD, USA.
Disabil Health J. 2018 Apr;11(2):192-203. doi: 10.1016/j.dhjo.2017.12.012. Epub 2018 Jan 10.
There is a concerted effort underway to evaluate and reform our nation's approach to the health of people with ongoing or elevated needs for care, particularly persons with chronic conditions and/or disabilities.
This literature review characterizes the current state of knowledge on the measurement of chronic disease and disability in population-based health services research on working age adults (age 18-64).
Scoping review methods were used to scan the health services research literature published since the year 2000, including medline, psycINFO and manual searches. The guiding question was: "How are chronic conditions and disability defined and measured in studies of healthcare access, quality, utilization or cost?"
Fifty-five studies met the stated inclusion criteria. Chronic conditions were variously defined by brief lists of conditions, broader criteria-based lists, two or more (multiple) chronic conditions, or other constructs. Disability was generally assessed through ADLs/IADLs, functional limitations, activity limitations or program eligibility. A smaller subset of studies used information from both domains to identify a study population or to stratify it by subgroup.
There remains a divide in this literature between studies that rely upon diagnostically-oriented measures and studies that instead rely on functional, activity or other constructs of disability to identify the population of interest. This leads to wide ranging differences in population prevalence and outcome estimates. However, there is also a growing effort to develop methods that account for the overlap between chronic disease and disability and to "segment" this heterogeneous population into policy or practice relevant subgroups.
目前，人们正在齐心协力，评估和改革我们国家对有持续或升高的护理需求人群（尤其是慢性病患者和/或残疾人）的健康管理方法。
本文献综述描述了当前在针对 18-64 岁工作年龄成年人的基于人群的健康服务研究中，对慢性病和残疾的测量方法的认识现状。
使用范围综述方法扫描了自 2000 年以来发表的健康服务研究文献，包括 medline、psycINFO 和手动搜索。指导问题是：“在研究医疗保健的可及性、质量、利用或成本的研究中，如何定义和衡量慢性病和残疾？”
有 55 项研究符合规定的纳入标准。慢性病通过简短的疾病清单、更广泛的基于标准的清单、两种或多种（多种）慢性病或其他结构来进行各种定义。残疾通常通过日常生活活动/工具性日常生活活动、功能限制、活动限制或计划资格来评估。较小的一部分研究使用了来自这两个领域的信息来确定研究人群或根据亚组对其进行分层。
在依赖诊断性指标的研究和依赖功能、活动或残疾其他结构来确定目标人群的研究之间，仍然存在分歧。这导致人群流行率和结果估计值存在广泛差异。然而，也越来越努力开发考虑慢性病和残疾之间的重叠并将这种异质人群“分割”为政策或实践相关亚组的方法。
