FRAMEWORK FOR IDENTIFYING CHILDREN WHO HAVE CHRONIC CONDITIONS - THE CASE FOR A NEW DEFINITION
FRAMEWORK FOR IDENTIFYING CHILDREN WHO HAVE CHRONIC CONDITIONS - THE CASE FOR A NEW DEFINITION
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DOI：
10.1016/s0022-3476(05)83414-6
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发表时间：
1993-03-01
影响因子：
5.1
通讯作者：
IREYS, HT
中科院分区：
文献类型：
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作者：
STEIN, REK;BAUMAN, LJ;IREYS, HT
确定患有持续健康状况的儿童的努力通常依赖于诊断清单。然而，越来越多的人倾向于使用非分类或通用的方法，根据其状况的后果来确定这些儿童。最近的立法和最高法院在Sullivan v Zebley一案中的裁决采用了这一更广泛的概念，并规定在确定是否有资格获得服务和福利时使用非分类方法。传统的病症列表是不太理想的，因为（1）不能包括儿童所经历的每种障碍，（2）临床医生和跨环境的诊断可能不一致，（3）单独的病症标签不传达个体的发病程度，（4）存在仅识别那些能够访问医疗保健系统的儿童的偏见，（5）症状或后果的出现与诊断之间往往存在差距。我们开发了一个非分类框架，用于识别患有持续健康状况的儿童，该框架响应联邦授权并使用疾病的后果，而不是诊断标签。它可用于满足服务、研究、政策、报销或计划资格的目标;在各种诊断中保持一致;描述发病率的影响;可适应特定目的;并可通过施加不同的严重程度进行修改。我们的筛选工具将很快投入实际使用。
Efforts to identify children with ongoing health conditions generally rely on lists of diagnoses. However, there has been a growing trend to use a noncategorical, or generic, approach in which such children are identified by the consequences of their condition. Recent legislation and the Supreme Court decision in Sullivan v Zebley adopt this broader concept and mandate that a noncategorical approach be used in determining eligibility for services and benefits. Traditional condition lists are less desirable because (1) every disorder to which children are subject cannot be included, (2) diagnoses may be applied inconsistently by clinicians and across settings, (3) condition labels alone do not convey the extent of morbidity for individuals, (4) there is a bias toward identifying only those children who have access to the medical care system, and (5) there is often a gap between emergence of symptoms or consequences and diagnosis. We developed a noncategorical framework for identifying children with ongoing health conditions that responds to the federal mandate and uses consequences of disorders, rather than diagnostic labels. It can be applied to meet the objectives of services, research, policy, reimbursement, or program eligibility; is consistent across diagnoses; is descriptive of the impact of morbidity; is adaptable to meet specific purposes; and can be modified by imposing different severity levels. Our screening tool will soon be available for practical use.