Framework and Historical Background

Outcomes research has its origins in the "outcomes movement" (Wennberg et al. 1980; Relman 1988; Epstein 1990). Its development is closely linked with the focus on measuring and assuring quality in the delivery of health services. The specific use of the term "outcomes research" can be traced to the efforts, beginning in the 1980s, of opinion leaders in health services research (e.g., Wennberg et al. 1980) and the Agency for Health Care Policy and Research to shift the focus of health services research from issues of the organization and processes of medical care to the outcomes of medical care. Many kinds of studies previously conducted under the rubric of clinical epidemiology, health services research, or clinical research are now called outcomes research. Other kinds of studies, especially the analysis of variations in practice, have been developed specifically under the rubric of outcomes research.

Information from outcomes research studies provides part of the information base for development of clinical practice guidelines. When definitive information from a large body of experimental research is not available, the result of outcomes research is the basis for decisions about how to manage patients in the clinical setting. Outcomes research is an element of evidence-based medicine (Naylor and Guyatt 1996) and increasingly, of continuous quality improvement and "disease management." Figure 8-1 shows how outcomes research flows into disease management and outcomes management toward the ultimate goal of improving the quality of care and patient outcomes (Epstein and Sherwood 1996).

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