Outcomes Research

  • Flemming Ørnskov
Conference paper


Outcomes research has only recently been recognized as a critical method of arriving at a health care decision which utilizes value to the patient as a guiding principle. In general, an outcome is a change in health status that a patient can notice, including such parameters as amelioration of symptoms, improvement in quality of life, and prolongation of life, while excluding anatomic, physiologic, and laboratory measures. Outcomes research, therefore, studies patient outcomes related to therapeutic intervention and attempts to incorporate the patient’s perspective together with measurements of cost and treatment effectiveness.

The ultimate goal of outcomes research is to study outcomes under daily clinical practice settings. Controlled clinical trials are, therefore, not an ideal way of conducting such research. However, clinical trials can be used as a means of collecting baseline data in order to mirror the impact of an intervention on resource utilization. When using data for clinical trials, physicians should evaluate to what extent the results can be generalized to the individual patient, and whether the outcomes that have been measured are important. In today’s health care climate the final analysis often involves balancing the probability of benefit and the associated costs and risks. Outcomes research is sometimes confounded with health economics; however, health economics is only one aspect of outcomes research and relates costs to medical effectiveness.

The practical application of outcomes research can take on various forms, e.g., outcomes management. Outcomes management is a population-based approach to generating desirable health outcomes. Great reliance is placed on standards and guidelines that physicians can use in selecting appropriate interventions. It is also a system which routinely and systematically measures the functioning and well-being of patients, along with disease-specific clinical outcomes, at appropriate time intervals. Under outcomes management programs, clinical and outcomes data are pooled on a massive scale and used as a basis for decision making. A related approach is disease management in which information systems are used to generate a cycle of continuous improvement in all aspects of care, including prevention, treatment, and management.


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  1. 1.
    Epstein RS, Sherwood LM (1996) From outcomes research to disease management: a guide to the perplexed. Ann Intern Med 124: 832–837PubMedGoogle Scholar
  2. 2.
    Herzlinger RE (1997) Market driven health care. Who wins, who loses in the transformation of America’s largest service industry. Addison-Wesley, Reading, MAGoogle Scholar
  3. 3.
    Sloan FA (ed) (1995) Valuing health care. Costs, benefits, and effectiveness of pharma-ceuticals and other medical technologies. Cambridge University Press, New YorkGoogle Scholar
  4. 4.
    Eisenberg JM (1986) Doctors’ decisions and the cost of medical care. The reasons for doctors’ practice patterns and ways to change them. Health Administration Press Perspectives, Ann ArborGoogle Scholar
  5. 5.
    Wennberg JE, Gittelsohn A (1997) Small area variations in health care delivery. Science 182: 1102–1108CrossRefGoogle Scholar
  6. 6.
    Wennberg JE, Gittelsohn A (1982) Variations in medical care among small areas. Sci Am 246(4): 120–134PubMedCrossRefGoogle Scholar
  7. 7.
    Eddy DM (1991) A manual for assessing health practices and designing practice policies: the explicit approach. The American College of Physicians, PhiladephiaGoogle Scholar
  8. 8.
    ørnskov F, Jönsson BG (1996) Comparing pharmacoeconomic data from different clinical trials. In: Spilker B (ed) Quality of life and pharmacoeconomics, 2nd edn. Lippin-cott-Raven, PhiladelphiaGoogle Scholar
  9. 9.
    Echt DS, Liebson PR, Michell LB et al (1991) Mortality and morbidity in patients receiving encainide, flecainide, or placebo: the Cardiac Arrhythmia Suppression Trial. N Engl J Med 324: 781–788PubMedCrossRefGoogle Scholar
  10. 10.
    The Cardiac Arrhythmia Suppression Trial II Investigators (1992) Effect of the antiar-rhythmic agent morocizine on survival after myocardial infarction. N Engl J Med 327–233Google Scholar
  11. 11.
    Freemantle N, Drummond M (1997) Should clinical trials with concurrent economic analyses be blinded? JAMA 277(1): 63–64PubMedCrossRefGoogle Scholar
  12. 12.
    Rittenhouse BE, O’Brien BJ (1996) Threats to the validity of pharmacoeconomic analyses based on clinical trial data. In: Spilker B (ed) Quality of life and pharmacoeconomics, 2nd edn. Lippincott-Raven, PhiladelphiaGoogle Scholar
  13. 13.
    Guyatt GH, Sackett DL, Cook DJ, for the Evidence-Based Working Group (1993) Users’ guide to the medical Literature, II: how to use an article about therapy or prevention, B: what were the results and will they help me in caring for my patients. JAMA 271: 59–63CrossRefGoogle Scholar
  14. 14.
    Drummond MF, Stoddart GL, Torrance GW (1987) Methods for the economic evaluation of health care programs. Oxford University Press, OxfordGoogle Scholar
  15. 15.
    Robinson R (1993) What does it mean? BMJ 307: 670–673PubMedCrossRefGoogle Scholar
  16. 16.
    Maynard A (1997) Evidence-based medicine: an incomplete method for informing treatment choices. Lancet 349: 126–160PubMedCrossRefGoogle Scholar
  17. 17.
    Ellwood PM (1988) Outcomes management: a technology of patient experience (Shat-tuck lecture). N Engl J Med 318: 1549–1556PubMedCrossRefGoogle Scholar
  18. 18.
    Jenings BM (1995) Outcomes: two directions — research and management. AACN Clin Issues 6(1): 79–88CrossRefGoogle Scholar
  19. 19.
    Avorn J (1996) Practice-based outcomes research: crucial, feasible, and neglected. Pediatrics 97: 113–114PubMedGoogle Scholar
  20. 20.
    Harris JM (1996) Disease management: new wine in new bottles? Ann Intern Med 124: 838–842PubMedGoogle Scholar
  21. 21.
    Tu JV, Pashos CL, Naylor CD et al (1997) Use of cardiac procedures and outcomes in elderly patients with myocardial infarction in the United States and Canada. New Engl J Med 336: 1500–1505PubMedCrossRefGoogle Scholar
  22. 22.
    Stewart AL, Greenfield S, Hays RD et al (1989) Functional status and well-being of patients with chronic conditions. JAMA 262: 907–913PubMedCrossRefGoogle Scholar
  23. 23.
    Osterhaus JT, Draugalis JR (1991) Application of pharmacoeconomics for drug therapy decision. In: Bootman JL, Townsend RJ, McGhan WF (eds) Principles of pharmacoeconomics. Harvey Whitney Books, CincinnatiGoogle Scholar
  24. 24.
    Kassirer JP (1994) Incorporating patients’ preferences into medical decisions. N Engl J Med 330(26): 1895–1896PubMedCrossRefGoogle Scholar
  25. 25.
    Smith R (1996) What clinical information do doctors need? BMJ 313: 1062–1068PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1998

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  • Flemming Ørnskov

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