Generating Evidence for Best Practice and Policies
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In an era of fundamental concerns about the way that health care is provided to individuals and populations, there is a need for a scientific discipline to bridge the capabilities of the medical profession and the best interests of patients and society. Assumptions about what is achieved by our healthcare system should be tested by evidence of what actually results from our efforts. Insights from the experience of patients should provide accountability for the investment in health care. Pledges of equity and fairness should be accompanied by proof that care is provided according to need and not race/ethnicity, sex, or socioeconomic status. The recognition that practical and applied knowledge was needed to guide practice and policy created an opportunity for the emergence of outcomes research. With this article, which provides a context for outcomes research, Circulation introduces a series that focuses on key topics in the field.
Outcomes research is defined by its focus on the result of healthcare interventions and policies.1,2 Themes of outcomes research are well reflected by Crossing the Quality Chasm: A New Health System for the 21st Century, a book from the Institute of Medicine that focuses attention on safety, effectiveness, equity, efficiency, timeliness, and patient-centeredness as key properties of high-quality health systems.3 This taxonomy provides a convenient organization for the survey of outcomes research. Moreover, these areas also provide important targets of study and intervention.
Additional emphasis is on the broad spectrum of patient outcomes in recognition that what seems best for patients and populations based on various sources of knowledge and intermediate or “proxy” outcomes often does not achieve its promise in actual practice and can occasionally produce unintended harmful consequences. The methods are broad and encompass the range of tools capable of resolving uncertainties about the outcomes of medical care. …