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Effectiveness and Outcomes in Health Care

Effectiveness and Outcomes in Health Care

Proceedings of an Invitational Conference

  • Publisher: National Academies Press
  • ISBN: 9780309078825
  • eISBN Pdf: 9780309543637
  • Place of publication:  United States
  • Year of digital publication: 1990
  • Month: January
  • Pages: 246
  • Language: English
  • Effectiveness and Outcomes in Health Care
  • Copyright
  • ACKNOWLEDGMENTS
  • PREFACE
    • EFFECTIVENESS VERSUS EFFICACY
    • METHODOLOGIES
    • IMPACT UPON COSTS
    • RISK ADJUSTMENTS AND OUTCOMES
    • CONCLUSIONS
  • Contents
  • PART I INTRODUCTION
    • 1 Genesis of the Effectiveness Initiative and IOM's Role
      • THE BROADER CONTEXT
        • The Institute of Medicine's Contribution
        • The IOM Clinical Workshop
        • The Condition-Specific Workshops
        • Effectiveness and Outcomes Conference
        • Proceedings
    • 2 Promise and Limitations of Effectiveness and Outcomes Research
      • IMPORTANCE OF EFFECTIVENESS RESEARCH
        • Medicare Data Bases
      • KEY ASPECTS OF EFFECTIVENESS RESEARCH
        • Reliability and Validity of Data
        • Longitudinal Studies
        • Tracking the Patient
        • Health Status Assessment
        • Risk Stratification
        • Prevention
        • The Aging Process
      • PRINCIPLES TO GUIDE FEDERAL EFFORTS
        • Range of Study Designs
        • Funding
        • Balance of Approaches
        • Coordination
        • Technology Assessment
        • Influencing Provider Behavior
        • The Confluence of Biomedical, Health Services, and Effectiveness Research
  • PART II OVERVIEW
    • 3 Research on the Effectiveness of Medical Treatment: New Challenges and Opportunities
      • Medical Treatment Effectiveness Program
        • Implementation of the Program
        • Priorities for Research
        • New Patterns of Collaboration
      • References
    • 4 The Health Care Financing Administration and the Effectiveness Initiative
      • HCFA'S INTEREST IN EFFECTIVENESS
      • THE EFFECTIVENESS INITIATIVE
      • FUTURE ACTIVITIES
      • ACKNOWLEDGEMENTS
    • 5 The Effectiveness Initiative: Retrospective and Prospects
      • THE GOVERNMENT'S ROLE IN EFFECTIVENESS RESEARCH
      • PROSPECTS
    • 6 The Social Perspective
      • THE PRESENT SCENARIO
      • COSTS OF HEALTH CARE
      • VARIATIONS IN MEDICAL COSTS AND PRACTICE
      • REASONS FOR THE EFFECTIVENESS INITIATIVE
      • HOW TO PROCEED IN EFFECTIVENESS AND OUTCOMES RESEARCH
    • 7 The Clinical Perspective
      • ISSUES IN THE USEFULNESS OF EFFECTIVENESS RESEARCH
      • MEETING PHYSICIANS' NEEDS
        • Accessibility of Results
        • Aiding Patient Invol Vement
        • Relation to Payment Mechanisms
        • Unbalanced Regulation
      • IMPACT OF THE EFFECTIVENESS INITIATIVE
      • Reference
    • 8 The Legislative Perspective
      • UNMET HEALTH CARE NEEDS
      • GROWING AWARENESS OF EFFECTIVENESS RESEARCH
      • THE CHALLENGE TO SCIENTISTS
      • CONCLUSION
  • PART III THE IOM CLINICAL CONDITION WORKSHOPS
    • The IOM Condition Workshops: Introduction
    • 9 Breast Cancer
      • THE PROBLEM OF POOR COMPLIANCE
      • CONTROVERSIES
        • Screening
        • Treatment
      • THE ROLE OF EFFECTIVENESS STUDIES IN BREAST CANCER
      • References
    • 10 Hip Fracture
      • PREVENTION
      • TREATMENT
      • IN-HOSPITAL CARE
      • REHABILITATION
      • CONCLUSION
    • 11 Claims Data and Effectiveness: Acute Myocardial Infarction and Other Examples
      • STRENGTHS OF CLAIMS DATA
      • GENERAL LIMITATIONS
        • Limitations for Diagnostic Devices
        • Limitations for Drugs
        • Limitations for Therapies
      • CONCLUSION
      • References
  • PART IV METHODOLOGICAL ISSUES AND WORK IN PROGRESS
    • Use of Large Data Bases: Introduction
    • 12 The Role of Large Data Bases in Effectiveness Research
      • SIZE OF LARGE DATA BASES
      • USES OF LARGE DATA BASES
      • MEDICARE DATA BASES
      • MEDICAID DATA BASES
    • 13 Administrative Data in Effectiveness Studies: The Prostatectomy Assessment
      • OVERVIEW OF THE PROSTATECTOMY ASSESSMENT
      • OVERVIEW OF METHODS
        • Case Identification and Variables
          • Outcomes
          • Patient Covariables
          • Treatment Variables
      • USES OF ADMINISTRATIVE DATA IN PROSTATECTOMY ASSESSMENT
        • Variations in Utilization Rates
        • Population-Based Estimates of Adverse Outcome Rates
        • Comparisons of Transurethral and Open Prostatectomy
      • IMPROVING THE USEFULNESS OF ADMINISTRATIVE DATA BASES
        • Strengths
        • Limitations
        • Suggestions
      • References
    • 14 Issues in the Use of Large Data Bases for Effectiveness Research
      • DEFINING LARGE DATA SETS
        • Population Base
        • Original Purpose
      • USES OF LARGE DATA BASES
        • Sampling Frames
        • Rates and Outcomes Surveillance
        • Variations in Outcomes
        • Linking Large Data Sets
      • LIMITATIONS OF LARGE DATA BASES
        • Data Quality
        • Timeliness
        • Access
      • METHODOLOGICAL ISSUES
        • Risk Adjustment
        • Treatment Selection
        • Provider-Procedure Interaction
        • Statistical Issues
          • Multiple Hypotheses
          • Processes in Control
      • RANDOMIZED CONTROLLED TRIALS VERSUS ANALYSIS OF LARGE DATA SETS
      • PROSPECTS
      • AN AGENDA
      • References
    • Collection of Primary Data: Introduction
    • 15 Measuring Patient Function and Well-Being: Some Lessons from the Medical Outcomes Study
      • CONCEPTS AND DATA SOURCES
      • DISEASE-SPECIFIC VERSUS GENERIC MEASURES
      • A MINIMUM SET OF GENERIC HEALTH CONCEPTS
      • THE MEDICAL OUTCOMES STUDY
      • FEASIBILITY AND COST
      • STANDARDS FOR EVALUATING MEASURES
      • USE OF HEALTH SURVEY DATA
      • ACKNOWLEDGEMENTS
      • References
    • 16 The Uniform Clinical Data Set
      • THE PRO CASE REVIEW PROCESS
      • THE UNIFORM CLINICAL DATA SET AND PRO NEEDS
        • Using the Uniform Clinical Data Set
        • Application of Findings
      • CONCLUSIONS
    • Development and Use of Outcome Measures: Introduction
    • 17 Assessing Health-Related Quality of Life Outcomes
      • QUANTITY AND QUALITY OF LIFE
      • SELECTION OF OUTCOMES
        • Sources For Analysis
          • Indexes
          • Profiles
          • Batteries
      • GENERIC AND SPECIFIC MEASURES
      • SHORT, RESPONSIVE MEASURES
      • CHANGES IN MEASURES
      • A THEORETICAL MODEL FOR HEALTH STATUS AND QUALITY OF LIFE
      • CONCLUSIONS
      • References
    • 18 Using Patient Reports of Outcomes to Assess Effectiveness of Medical Care
      • LINKING PROCESS AND OUTCOME
        • Early Studies of Outcome
        • The Need For Disease-Specific Measures
      • SCOPE OF THE STUDY
        • Patient Questionnaire
        • Findings
      • CONCLUSIONS
      • References
    • 19 Studying Outcomes for Patients with Depression: Initial Findings From the Medical Outcomes Study
      • THE MEDICAL OUTCOMES STUDY
        • Health Care Setting
        • Initial Samples
      • THE STUDY OF DEPRESSION
        • Identifying Patients With Depression
        • Assessing Outcomes
      • RESULTS OF THE DEPRESSION STUDY
        • Findings From the Baseline Data
        • Preliminary Findings From the Longitudinal Data
      • CONCLUSION
      • References
    • Application to Clinical Practice: Introduction
    • 20 Effectiveness Research and Changing Physician Practice Patterns
      • EFFECTS OF RESEARCH ON MEDICAL PRACTICE
        • Clinical Trials
        • Consensus Development Conferences
      • WHAT SHOULD BE DONE
      • References
    • 21 Applying Effectiveness and Outcomes Research to Clinical Practice
      • WHAT IS DIFFERENT ABOUT EFFECTIVENESS AND OUTCOMES RESEARCH?
      • A CLINICAL EXAMPLE: OUTCOME PROBABILITIES IN DECISION MAKING
      • SOURCES OF PROBABILITIES AND A ROLE FOR OUTCOMES RESEARCH
      • VALUE JUDGMENTS IN DECISION MAKING
      • VALUE JUDGMENTS AND THE ROLE OF OUTCOMES RESEARCH
      • CONCLUSIONS
      • References
    • 22 An Attempt to Manage Variation in Obstetrical Practice
      • THE HARVARD COMMUNITY HEALTH PLAN EXPERIENCE
        • The Choice of Obstetrical Care
        • Variations in Practice Between Two Hospitals
        • Possible Causes of the Variations
        • The Attempt to Change Process of Care
        • Preliminary Results
      • LESSONS
      • A CAUTION
      • ACKNOWLEDGMENTS
    • 23 Using Outcome Measures to Improve Care Delivered by Physicians and Hospitals
      • OUTCOMES MEASUREMENT/IMPROVEMENT SYSTEMS FOR MEDICAL PRACTICES
        • The Coop Charts
      • THE RUBENSTEIN FUNCTIONAL HEALTH STATUS APPROACH
      • MEASUREMENT/IMPROVEMENT SYSTEMS FOR HOSPITALS
        • HCA Patient Judgment System
      • SOUTH SHORE HOSPITAL GERIATRIC ASSESSMENT AND PLANNING PROGRAM
      • HALLMARKS OF MEASUREMENT/IMPROVEMENT SYSTEMS
      • USE OF OUTCOMES MEASURES TO BENEFIT A PATIENT POPULATION
      • CONCLUSION
      • References
  • PART V WHERE DO WE GO FROM HERE?
    • 24 The Need for Reasonable Expectations
      • THE LIKELIHOOD OF UNMET EXPECTATIONS
      • WHAT EFFECTIVENESS RESEARCH CAN DO
      • References
    • 25 Use of Effectiveness Research in Managed Care Plans
      • IMPORTANCE OF OUTCOMES RESEARCH
      • CURRENT APPLICATIONS OF OUTCOMES RESEARCH
        • Clinical Protocols
        • Technology Assessment
      • INSURERS' ROLE IN EFFECTIVENESS RESEARCH
      • LIMITATIONS OF THE EFFECTIVENESS ''STRATEGY''
      • Reference
    • 26 Gaining Acceptance for Effectiveness and Outcomes Research
      • REASONS FOR PURSUING RESEARCH
      • WHO MUST BE CONVINCED?
      • WHO WILL PUSH FOR RESEARCH?
      • References
  • LIST OF AUTHORS

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