Defining Comorbidity: Implications for Understanding Health and Health Services
Defining Comorbidity: Implications for Understanding Health and Health Services
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DOI：
10.1370/afm.983
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发表时间：
2009-07-01
影响因子：
4.4
通讯作者：
Roland, Martin
中科院分区：
文献类型：
--
作者：
Valderas, Jose M.;Starfield, Barbara;Roland, Martin
共病与更差的健康结局、更复杂的临床管理和更高的医疗费用有关。然而，这个术语的含义没有达成一致，相关的概念，如多发病、发病率负担和患者复杂性，也没有很好的概念化。在这篇文章中，我们回顾了共病的定义及其与相关概念的关系。我们表明，给定结构的价值在于它能够解释(1)临床护理、(2)流行病学或(3)卫生服务规划和融资领域内的特定感兴趣的现象。研究了两种或两种以上病症共存的机制(直接原因、相关危险因素、异质性、独立性)，并考虑了对临床护理的影响。我们的结论是，本文建议的更精确的结构使用将导致对临床护理、流行病学和卫生服务中的不良健康现象的更好的研究。
Comorbidity is associated with worse health outcomes, more complex clinical management, and increased health care costs. There is no agreement, however, on the meaning of the term, and related constructs, such as multimorbidity, morbidity burden, and patient complexity, are not well conceptualized. in this article, we review definitions of comorbidity and their relationship to related constructs. We show that the value of a given construct lies in its ability to explain a particular phenomenon of interest within the domains of (1) clinical care, (2) epidemiology, or (3) health services planning and financing. Mechanisms that may underlie the coexistence of 2 or more conditions in a patient (direct causation, associated risk factors, heterogeneity, independence) are examined, and the implications for clinical care considered. We conclude that the more precise use of constructs, as proposed in this article, would lead to improved research into the phenomenon of ill health in clinical care, epidemiology, and health services.