Wilson I B, Kaplan S
Department of Medicine, Tufts University Medical School, Boston, MA, USA.
Med Care. 1995 Apr;33(4 Suppl):AS209-14.
Now that we have the ability to measure patients' health outcomes, physicians and health care systems need to know how to manage these outcomes. What are the causal pathways that link clinical and health status concepts? What are the key points at which physicians and health care systems can intervene in effective and cost-effective ways? We have argued that the elegant biomedical model that physicians use to understand disease is a blunt tool in the dissection of illness and that valid, reliable, and richly descriptive measures of HRQL fail at clinical tasks because causal linkages between clinical processes and health status outcomes have not yet been made convincingly, at either the conceptual or the empiric level. One approach to this problem is to develop and test causal models that explore the relationships among different measures of health status in an attempt to elucidate the "genesis" and "pathogenesis" of disorders of HRQL. Once physicians and health care systems know more about the determinants of poor health status and the mechanisms by which it occurs, creative attempts to intervene at multiple points in a causal pathway may be possible, making outcomes management a more realistic goal.
既然我们有能力衡量患者的健康结果，医生和医疗保健系统就需要知道如何管理这些结果。将临床概念与健康状况概念联系起来的因果途径是什么？医生和医疗保健系统能够以有效且具有成本效益的方式进行干预的关键点有哪些？我们认为，医生用于理解疾病的精妙生物医学模型在剖析疾病时是一种钝器，而且由于在概念层面或实证层面，临床过程与健康状况结果之间的因果联系尚未得到令人信服的确立，有效的、可靠的且描述丰富的健康相关生活质量测量方法在临床任务中并不成功。解决这个问题的一种方法是开发并测试因果模型，该模型探索不同健康状况测量指标之间的关系，试图阐明健康相关生活质量障碍的“起源”和“发病机制”。一旦医生和医疗保健系统对健康状况不佳的决定因素以及其发生机制有了更多了解，就有可能在因果途径的多个点进行创造性干预，使结果管理成为一个更现实的目标。
