Outcomes research has altered the culture of clinical practice and health care research by changing how we assess the end results of health care services.
In doing so, it has provided the foundation for measuring the quality of care. The results of AHRQ outcomes research are becoming part of the "report cards" that purchasers and consumers can use to assess the quality of care in health plans.
For public programs such as Medicaid and Medicare, outcomes research provides policymakers with the tools to monitor and improve quality both in traditional settings and under managed care.
The results of outcomes research studies can support policy decisions, provider treatment decisions, formulary drug selection, treatment protocols, and other processes within a health care system. Many steps are involved in performing outcomes research. The manner in which they are conducted is variable, depending upon the group conducting the study i. The design of the study for an outcomes evaluation first requires the researcher to establish the perspective from which conclusions will be reached, particularly related to costs and consequence.
The results of an evaluation will vary greatly depending upon the perspective established. For example, the research would be very different if researchers took a societal perspective vs. Other perspectives could be that of a payer such as an insurer or the government or an individual institution such as a hospital or medical group.
Additionally, the alternatives within an evaluation need to be established and weighted appropriately based on their respective probabilities of occurring. These probabilities can be derived from expert panels, a literature review, or clinical trial data. After data are collected and analyzed, a sensitivity analysis is conducted to compensate for uncertainty. A sensitivity analysis incorporates a "what if" process to test the assumptions or estimates made within the study process when precise input values could not be acquired.
Pharmacists are important contributors in conducting outcomes research processes with roles in the following areas:. Identifying topic areas for outcomes evaluation.
Example: Asthma is a topic area that could be identified via tracking of medication use trends inconsistent with national treatment guidelines. In addition, asthma might be identified in a population where emergency room admissions for acute attacks are higher than national averages. Evaluating the published literature. For the pharmacist, reading and using the published results from outcomes research studies is similar to using the results from any research.
Example: A review of the literature would be conducted to assess current standards of practice and national treatment guidelines for asthma. A literature review would also identify those study strategies that have been successful or unsuccessful for the treatment of asthma, and aid in designing the project.
Designing evaluations. Special training is required to design valid outcomes evaluation studies and analyze the findings. Individuals who have expertise in this discipline i. Understanding the population served by the health care system is essential to the design process and assures that the evaluation, its results, and the implementation of correction strategies are of value to the patient population and the system conducting the evaluation.
Example: Evaluation studies for the treatment of asthma could involve a detailed study of a group's demographics. In this case, a study for a population of pediatric patients would have a significantly different design and set of validation tools than a study for adult patients. For example, a follow-up questionnaire to pediatric patients must not only be statistically validated, but it must also be in appropriate language for a child, the parents, or guardians to understand in order to elicit accurate information.
Analyzing and assessing results. While good design may ensure results will be useful, the ability to critically analyze the results in light of study objectives is an important step. We need information about how to engage patients in decision making, the cost-effectiveness of treatments, and the impact of health care policy decisions on various patient outcomes. Outcomes research can provide answers to most if not all of these questions. It increases your knowledge and understanding of various research methodologies as mentioned before.
Finally, at the individual or personal level, engaging in outcomes research also enables you to collaborate and share ideas with peers, and most importantly, seek mentors both at and outside your institution with whom you can develop life-long relationships. As someone once said, "If you want to be incrementally better: be competitive. If you want to be exponentially better: be cooperative.
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