改进美国老年人的健康和医疗卫生英文文献及中英文翻译.doc

Improving the Health and Health Care of Older Americans Arlene Bireman, William Spector Introduction As we enter the new millennium, the Nation is confronted with the enormous challenge of preparing to meet the demands of an aging society. In the face of current demographic trends, increasing health care costs, and concerns about the quality of health care, the financing and delivery of care for older people is a critical health care policy challenge Figure 1 The Conceptual Framework of a Patient-centered Health Policy Early in the related discussions, we decided to focus our efforts on cost-effective interventions that enhance functioning and health-related quality of life HRQOL or prevent functional decline. With this decision, we focused on gaps in knowledge that influence the ability of health care services to improve functioning and HRQOL including costs, financing, barriers to access, organization and delivery of care, and clinical practice, as well as the interaction of these factors with individual patient characteristics and preferences, family, and community. Figure 1 describes the conceptual framework we used. It includes a patient-centered rather than disease-specific focus. This framework also recognizes the role of health policy in influencing patient outcomes. All of the arrows on our framework are bidirectional, recognizing the multiple, complex interrelationships that influence health and function in older people. A focused research effort to determine how the health care system can most cost-effectively prevent disability, reduce functional decline, and extend active life expectancy in older people can provide decisionmakers with the information needed to accelerate the decline in age-specific disability rates and to allocate limited resources efficiently Delivering Health Care to an Aging Population An aging population, together with rising health care costs and rapid health system Change, presents a