VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Medicine, Health Services Research, Baylor College of Medicine, Houston, Texas.
VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Sociology, University of Houston-Clear Lake, Houston, Texas.
Clin Gastroenterol Hepatol. 2020 May;18(5):1015-1024. doi: 10.1016/j.cgh.2019.07.043. Epub 2019 Jul 26.
Advanced liver disease (AdvLD) is a high-risk common condition with a progressive, highly morbid, and often fatal course. Despite effective treatments, there are substantial shortfalls in access to and use of evidence-based supportive and palliative care for AdvLD. Although patient-centered, chronic illness models that integrate early supportive and palliative care with curative treatments hold promise, there are several knowledge gaps that hinder development of an integrated model for AdvLD. We review these evidence gaps. We also describe a conceptual framework for a patient-centered approach that explicates key elements needed to improve integrated care. An integrated model of AdvLD would allow clinicians, patients, and caregivers to work collaboratively to identify treatments and other healthcare that best align with patients' priorities.
晚期肝病(AdvLD)是一种高风险的常见病症,具有进行性、高度病态和常常致命的病程。尽管有有效的治疗方法,但在获得和使用基于证据的支持性和姑息性治疗方面,仍然存在很大的差距。尽管以患者为中心的慢性病模式将早期支持性和姑息性治疗与治愈性治疗相结合具有很大的潜力,但仍有几个知识差距阻碍了 AdvLD 综合模式的发展。我们回顾了这些证据差距。我们还描述了一个以患者为中心的方法的概念框架,阐明了改善综合护理所需的关键要素。AdvLD 的综合模式将使临床医生、患者和护理人员能够共同努力,确定最符合患者优先事项的治疗方法和其他医疗保健。