1. Handbook for Health Care Research, Second Edition Chapter 3 © 2010 Jones and Bartlett Publishers, LLC CHAPTER 3 Outcomes Research

2. 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 2

3. 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? 3

4. 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 4

5. Handbook for Health Care Research, Second Edition Chapter 3 © 2010 Jones and Bartlett Publishers, LLC Focus and Methods of Outcomes Research 5 Outcomes research is different than traditional research Traditional Clinical ResearchOutcomes Research Disease-centeredPatient and community-centered Drugs and devicesProcesses and delivery of care ExperimentalObservational Methods from “hard sciences” (e.g., physics, biochemistry) Methods from “social sciences” (e.g., economics, epidemiology) EfficacyEffectiveness Mechanisms of diseaseConsequences of disease on patients Effects of biochemical and physiologic factors Effects of socioeconomic factors

6. Handbook for Health Care Research, Second Edition Chapter 3 © 2010 Jones and Bartlett Publishers, LLC Various Types of Outcome Measures Used in Outcomes Research 6

7. Handbook for Health Care Research, Second Edition Chapter 3 © 2010 Jones and Bartlett Publishers, LLC7

8. 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 8

9. 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? 9

10. 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? 10

11. 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 11

12. 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 12

13. 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) 13 * Burgundy text added by JMB

14. 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 ) 14 * Burgundy text added by JMB