Kaplan R M, Anderson J P
Department of Community and Family Medicine, University of California, San Diego, La Jolla 92093.
Health Serv Res. 1988 Jun;23(2):203-35.
This article describes the development of a General Health Policy Model that can be used for program evaluation, population monitoring, clinical research, and policy analysis. An important component of the model, the Quality of Well-being scale (QWB) combines preference-weighted measures of symptoms and functioning to provide a numerical point-in-time expression of well-being, ranging from 0 for death to 1.0 for asymptomatic optimum functioning. The level of wellness at particular points in time is governed by the prognosis (transition rates or probabilities) generated by the underlying disease or injury under different treatment (control) variables. Well-years result from integrating the level of wellness, or health-related quality of life, over the life expectancy. Several issues relevant to the application of the model are discussed. It is suggested that a quality of life measure need not have separate components for social and mental health. Social health has been difficult to define; social support may be a poor criterion for resource allocation; and some evidence suggests that aspects of mental health are captured by the general measure. Although it has been suggested that measures of child health should differ from those used for adults, we argue that a separate conceptualization of child health creates new problems for policy analysis. After offering several applications of the model for the evaluation of prevention programs, we conclude that many of the advantages of general measures have been overlooked and should be given serious consideration in future studies.
本文描述了一种通用健康政策模型的开发，该模型可用于项目评估、人群监测、临床研究和政策分析。该模型的一个重要组成部分——幸福质量量表（QWB），将症状和功能的偏好加权测量相结合，以提供幸福的即时数值表达，范围从死亡时的0到无症状最佳功能时的1.0。特定时间点的健康水平由不同治疗（对照）变量下潜在疾病或损伤产生的预后（转移率或概率）决定。健康年数是通过将健康水平或与健康相关的生活质量在预期寿命内进行整合得出的。讨论了与该模型应用相关的几个问题。有人认为，生活质量测量无需为社会健康和心理健康设置单独的组成部分。社会健康难以界定；社会支持可能不是资源分配的良好标准；而且一些证据表明，心理健康的各个方面可由综合测量涵盖。尽管有人提出儿童健康测量应与成人所用测量不同，但我们认为对儿童健康进行单独概念化会给政策分析带来新问题。在介绍了该模型在预防项目评估中的若干应用后，我们得出结论，综合测量的许多优点被忽视了，在未来研究中应予以认真考虑。
