[Medical Methods: What Makes them Necessary? Part I: Medical Methods, medical Necessity and its Main Criteria].
[Medical Methods: What Makes them Necessary? Part I: Medical Methods, medical Necessity and its Main Criteria].
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[医疗方法：什么使它们必要？
DOI：
10.1055/a-0965-6866
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Bettina Schoene-Seifert
中科院分区：
文献类型：
--
作者：
Heiner;Daniel R. Friedrich;Anke Harney;Stefan Huster;Bettina Schoene-Seifert
目的”医疗需要”（MedN）是一个模糊术语。我们的项目旨在具体化医学伦理，社会法和社会医学之间的概念，以支持医疗保健监管，主要是在德国的法定医疗保险体系。在之前的出版物中，我们将MedN确定为三方等同器械：特定的临床状况需要特定的医疗干预才能达到特定的医疗目标。我们的两部分文本搜索并讨论了将医疗方法分类为一般医疗必要（medn）的标准，提供了一个重要的临床条件和一个相关的，合法的，实际存在的可达到的目标。在本文中，我们提出了第一部分，我们的results.MethodsBased上广泛的伦理，社会法律和社会医学机构的文献，并开始与一个无争议的情况下的小插曲（溶栓在急性中风），我们一般遵循一个关键的重建方法。首先，我们定义了“医疗方法”一词。在几个跨学科的回合中，我们从三个来源收集和讨论了标准：制定临床实践指南作为适应症规则纲要的方法，瑞典卫生保健国家优先模式，和欧洲卫生技术评估网络的HTA核心模型作为政治咨询的工具。ResultsWe确定了一般临床疗效和益处作为2个主要的”医疗”MedN标准。作为第三个认识标准，相应的证据体总是要考虑的。由于临床和优先级指南对他们的建议进行了分级，因此出现了一个问题，即MedN是否应被概念化为二分或更精细分级的等同器械。按照德国社会法的雅阁，我们主张二元形式。进一步的讨论集中在多因素MedN-配置，长期的范围内，和变化的证据requirements.ConclusionsNo如何的内容MedN的概念化，它似乎不可能包括其标准的算法。因此，在制定一项将医疗方法归类为医疗必要性的计划的任何阶段，深思熟虑的努力都是必不可少的。
Objectives" Medical necessity"(MedN) is a fuzzy term. Our project aims at concretising the concept between medical ethics, social law, and social medicine to support health care regulation, primarily within Germany's statutory health insurance system. In a previous publication we identified MedN as a tripartite predicate: A specific clinical condition requires a specific medical intervention to reach a specific medical goal. Our two-part text searches for and discusses criteria to classify medical methods as generally medically necessary (medn), provided a non-trivial clinical condition and a relevant, legitimate, and reachable goal actually exist. In this paper we present the first part of our results.MethodsBased on an extensive ethical, sociolegal and sociomedical body of literature, and starting with an non-controversial case vignette (thrombolysis in acute stroke), we generally followed a critical reconstructive approach. First we defined the term" medical method". In several interdisciplinary rounds, we then collected and discussed criteria from three sources: methods to develop clinical practice guidelines as compendia of indication rules, the National Model of Prioritisation in Swedish Health Care, and the HTA Core Model of the European Network for Health Technology Assessment as an instrument of political counselling.ResultsWe identified general clinical efficacy and benefit as the 2 main" medical" criteria of MedN. As a third-epistemic-criterion, the corresponding bodies of evidence are always to be considered. Since clinical and prioritising guidelines grade their recommendations, the question arises whether MedN should be conceptualised as a dichotomous or finer graded predicate. In accord with German social law we advocate for the binary form. Further discussions focused on multifactorial MedN-configurations, the range of the term, and the variability of evidence requirements.ConclusionsNo matter how the content of MedN is conceptualised, it seems impossible to include its criteria in an algorithm. So deliberative effort is indispensable at any stage of developing a programme to classify medical methods as medically necessary.
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发表时间：
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期刊：
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影响因子：
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作者：
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影响因子：
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作者：
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发表时间：
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