The existence of persistent variations in practice offer a potent reminder that substantial challenges remain in translating products of outcomes and effectiveness research into improved outcomes for patients. The Dartmouth Atlas , a compendium of practice variations in the United States, provides an annual update on the net impact of efforts to improve outcomes and quality of care for individual patients and populations.
Work on geographic variations in medical practice, appropriateness of care, and the poor quality of medical evidence set the stage for the "Effectiveness Initiative" announced in 1988. The work of John E. Wennberg, M.D., M.P.H., and colleagues at Dartmouth Medical School provided seminal evidence of the urgent need for high-quality evidence to inform multiple clinical decisions made daily in typical practice settings across the country.
When established in 1989, the Agency for Health Care Policy and Research, now the Agency for Healthcare Research and Quality (AHRQ), had primary responsibility for carrying the Effectiveness Initiative forward. The Effectiveness Initiative itself represented an important hypothesis:
Guidance for optimal medical practice could be gleaned from analysis of data routinely gathered in the process of delivering and paying for patient care.
The output from the Agency's program for outcomes research over the past decade offers some empirical evidence with which to assess its validity.
Outcomes and effectiveness research (OER) evaluates the impact of health care (including discrete interventions such as particular drugs, medical devices, and procedures as well as broader programmatic or system interventions) on the health outcomes of patients and populations. OER studies have often provided descriptive data that challenged prevailing clinical ideas about how best to manage specific clinical problems. Documenting patterns of care or outcomes that are inconsistent with existing understandings of disease processes and management creates a tension that can lead to further study or directly to changes in practice.
The most concrete accomplishments of the first 10 to 15 years of OER are the tools and analytic methods that have been developed, including:
- Strategies for conducting systematic reviews and meta-analysis.
- Instruments for measuring health outcomes important to patients.
- Sophisticated techniques for analyzing observational data to adjust for disease severity and minimize
Some findings from OER may not be definitive enough to influence practice, but may help direct future research efforts. Public funding for OER has produced a network of institutions and trained investigators capable of carrying out OER. Beginning with a relatively small core of academic centers and professionals, there are now large numbers of individuals and institutions pursuing outcomes studies in the public and private sectors.
Select for a detailed report, "The Outcome of Outcomes Research at AHCPR."
Current as of May 2001
Atlas Updates Impact of Outcomes Efforts. May 2001. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/dartmout.htm