A Health-Status Index and its Application to Health-Services Outcomes
A Health-Status Index and its Application to Health-Services Outcomes
复制标题
健康状况指数及其在健康服务成果中的应用
作者：
S. Fanshel;J. Bush
为了给健康下一个可操作的定义，我们发现有必要首先将功能/功能障碍的概念发展为一个连续体，以一个人进行与社会角色相适应的日常活动的能力为基础。然后，对于那些运营卫生系统的人来说，人口中的每个成员都可以被视为属于且只能属于一个州，这些州可以按顺序定义为一类功能州。接下来，我们发现有必要为每个州分配一个以基数尺度定义的权重，这些州的权重集称为健康状态指数（HSI）。恒生指数基于社会性质的价值判断，由负责政策决策的管理者表达。预后则定义为功能状态随时间变化的过渡概率。因此，“健康状况”和“疾病严重程度”的概念被分解为功能/功能障碍和预后参数。最后，结合时间和目标人群的可操作性定义，就有可能对卫生计划（或卫生系统）的输出给出定量定义，即卫生计划（或系统）的干预导致目标人群功能历史的变化。给予定量定义的其他概念是方案有效性和人口健康状况。接下来，本研究探讨了卫生项目产出与项目规划的现代决策理论之间的关系，并展示了这些分析工具如何有助于将研究结果融入更大的概念框架。最后，首先用一个简化的计算机模拟程序来说明所开发的方法，然后对结核控制程序的一小部分进行分析。
In order to develop an operational definition of health, we found it necessary first to develop the concept of function/dysfunction as a continuum, based on one's ability to carry on the usual daily activities appropriate to social roles. Then, to those operating the health system, each member of the population can be seen as belonging to one and only one state from a class of functional states that can be defined on an ordinal scale. Next, we found it necessary to assign to each state a weight defined on a cardinal scale, the set of weights for these states being called the Health Status Index (HSI). The HSI rests on value judgments, of a societal nature, expressed by the administrators responsible for policy decisions. Prognosis is then defined as the transitional probability of a change in functional state with time. Thus, the concepts “state of health” and “severity of illness” are decomposed into the parameters function/dysfunction and prognosis. Finally, together with an operational definition of time and target population, it becomes possible to give a quantitative definition of the output of a health program (or health system) as the changes in the functional history of the target population resulting from the intervention of the health program (or system). Other concepts that are given quantitative definitions are program effectiveness and population health status. This study next explores the relation between health program output and modern decision theory for program planning, and shows how these analytical tools are useful for fitting the results of the study into larger conceptual frameworks. Finally, the method developed is illustrated, first with a simplified simulated program for computer use, and then with an analysis of a small section of a tuberculosis-control program.