Perrin E C, Newacheck P, Pless I B, Drotar D, Gortmaker S L, Leventhal J, Perrin J M, Stein R E, Walker D K, Weitzman M
Dept of Pediatrics, University of Massachusetts Medical Center, Worcester 01655.
Pediatrics. 1993 Apr;91(4):787-93.
The need for a widely applicable definition of chronic conditions for research, policy, and program development has led to an extensive review of the development of such definitions, the considerations involved in their use, and some recommendations for a new approach. This paper examines some of the methodologic and conceptual issues related to defining and classifying chronic conditions and describes some consequences resulting from decisions made about these issues. While most examples are taken from child health applications, the basic concepts apply to all age groups. The dominant method for identifying and classifying children as having a chronic condition has relied on the presence of an individual health condition of lengthy duration. This condition-specific or "categorical" approach has increasingly seemed neither pragmatically nor conceptually sound. Thus, the development of a "generic" approach, which focuses on elements that are shared by many conditions, children, and families, is recommended. Such a definition might reflect the child's functional status or ongoing use of medical services over a specified time period. In addition, it is suggested that conditions be classified based on the experience of individual children, thus emphasizing the tremendous variability in expression of seemingly similar conditions.
为了给研究、政策制定和项目开发提供一个广泛适用的慢性病定义，人们对这类定义的发展、使用时的考量因素以及一种新方法的建议进行了广泛的审视。本文探讨了与慢性病定义和分类相关的一些方法学和概念性问题，并描述了就这些问题所做决策产生的一些后果。虽然大多数例子取自儿童健康应用，但基本概念适用于所有年龄组。将儿童认定为患有慢性病并进行分类的主要方法一直依赖于存在持续时间较长的个体健康状况。这种针对特定疾病或“分类”的方法在实际应用和概念上越来越显得不合理。因此，建议开发一种“通用”方法，该方法侧重于许多疾病、儿童和家庭所共有的要素。这样的定义可能反映儿童在特定时间段内的功能状态或持续使用医疗服务的情况。此外，建议根据个体儿童的经历对疾病进行分类，从而强调看似相似的疾病在表现上的巨大差异。
