Handbook for Health Care Research, Second Edition Chapter 3

© 2010 Jones and Bartlett Publishers, LLC

CHAPTER 3Outcomes Research

Handbook for Health Care Research, Second Edition Chapter 3

© 2010 Jones and Bartlett Publishers, LLC

Outcomes Research-Origin• Florence Nightingale may have been the

forerunner of outcomes researcher• Modern outcomes research birthed from cost

containment in 1980s• Need to eliminate unnecessary medical

processes and procedures

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Handbook for Health Care Research, Second Edition Chapter 3

© 2010 Jones and Bartlett Publishers, LLC

Agency for Healthcare Research and Quality (AHRQ)

Outcomes research is about•What works? •What doesn’t? •When in the course of an illness (does it work or not)? •At what cost?

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Handbook for Health Care Research, Second Edition Chapter 3

© 2010 Jones and Bartlett Publishers, LLC

Outcomes Research Speaks Its Own Language

• Lack of uniform definitions• Outcomes research is scientific study of the

results of diverse therapies used for particular diseases, conditions, or illnesses

• Outcomes research is linked to evidence based medicine

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Handbook for Health Care Research, Second Edition Chapter 3

© 2010 Jones and Bartlett Publishers, LLC

Focus and Methods of Outcomes Research

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• Outcomes research is different than traditional researchTraditional Clinical Research Outcomes Research

Disease-centered Patient and community-centered

Drugs and devices Processes and delivery of care

Experimental Observational

Methods from “hard sciences” (e.g., physics, biochemistry)

Methods from “social sciences” (e.g., economics, epidemiology)

Efficacy Effectiveness

Mechanisms of disease Consequences of disease on patients

Effects of biochemical and physiologic factors

Effects of socioeconomic factors

Handbook for Health Care Research, Second Edition Chapter 3

© 2010 Jones and Bartlett Publishers, LLC

Various Types of Outcome Measures Used in Outcomes Research

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Category Type Example Clinical Clinical events Myocardial infarct Physiologic measures Pulmonary function indices Mortality Asthma deaths Economic Direct medical costs Hospital and outpatient visits Indirect costs Work loss, restricted activity days Humanistic

Symptoms

Dyspnea scores

Quality of life SF-36 Questionnaire, St. George’s Respiratory Questionnaire (SGRQ) Functional status

Patient satisfaction Activities of daily living

Handbook for Health Care Research, Second Edition Chapter 3

© 2010 Jones and Bartlett Publishers, LLC 7

Handbook for Health Care Research, Second Edition Chapter 3

© 2010 Jones and Bartlett Publishers, LLC

Helpful Tools• Meta-analysis• Decision analysis• Economic evaluations: cost identification, cost

of illness, cost minimization, cost benefit analysis, and cost utility analysis

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Handbook for Health Care Research, Second Edition Chapter 3

© 2010 Jones and Bartlett Publishers, LLC

Efficacy versus Effectiveness• Efficacy studies: Does the intervention work in

a tertiary care setting with carefully selected patients under tightly controlled conditions?

• Effectiveness studies: Does the intervention work in clinical practice settings with unselected patients, typical care providers, and usual procedures?

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Handbook for Health Care Research, Second Edition Chapter 3

© 2010 Jones and Bartlett Publishers, LLC

Outcomes of Outcome Research• Is outcomes research helpful? • What type of investment is needed to assess

effectiveness of outcomes research?• Are findings important in clinical practices?

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Handbook for Health Care Research, Second Edition Chapter 3

© 2010 Jones and Bartlett Publishers, LLC

Benchmarking• How can justify current practices without

research?• Benchmarking: standard or point of reference

in measuring quality• Types of benchmarking: collaborative,

functional, and internal

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Handbook for Health Care Research, Second Edition Chapter 3

© 2010 Jones and Bartlett Publishers, LLC

Benchmarking Keys• Identifying critical success factors and

determining key indicators • Collecting information relevant to the key

indicators • Searching to identify extraordinary performers,

as defined by the data • Identifying the factors that drive superior

performance • Adopting or adapting those factors that fit into

your processes

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Handbook for Health Care Research, Second Edition Chapter 3

© 2010 Jones and Bartlett Publishers, LLC

Benchmarking Indicators• Ratio indicators establish a relationship between two

measures (hours per patient day – HPPD*)• Process indicators measure a process with a beginning

point and an ending point (turnaround time - TAT)• Outcome indicators measure clinical outcomes (patient

returns to the emergency department within 24 hours)

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* Burgundy text added by JMB

Handbook for Health Care Research, Second Edition Chapter 3

JMB Acronyms

Chapter 3 Acronyms*• AHCPR• AHRQ• PORT• CQI• PDCA• TJC• SGRQ• QALYs• QOL• HPPD (hours per patient day)• TAT (turnaround time )

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* Burgundy text added by JMB