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A full decade of outcomes and effectiveness research (OER) has built a solid foundation for future quality improvement efforts in health care by identifying problems, generating hypotheses, and developing new methodologies. Yet OER has had limited direct impact on health care policies, practices, and outcomes, according to this recent study. Daniel Stryer, M.D., Heddy Hubbard, R.N., M.P.H., and Carolyn Clancy, M.D., of the Agency for Healthcare Research and Quality, and Sean Tunis, M.D., M.Sc., now at the Health Care Financing Administration, Baltimore, MD, surveyed all principal investigators (PIs) of OER projects funded by AHRQ between 1989 and 1997 to identify their most salient research findings.
Many investigators identified studies that were descriptive, providing important information about who is affected by a disease, how patients are managed, and what the consequences of management are. Many studies were hypothesis generating, leading to refinement of specific clinical questions and subsequent studies. Methodological studies laid the foundation necessary for subsequent work. These included techniques to adjust for patient differences in disease severity, meta-analysis, measurement of patient-oriented outcomes (such as improved vision after cataract surgery versus a physical measurement of visual acuity), and development of models that relate the process of care to those outcomes.
Of the 91 investigators who reported on 115 studies, 24 percent had findings classified as descriptive epidemiology, 17 percent compared the effectiveness of one medical procedure with another, and 12 percent conducted economic assessments. The second, third, and fourth largest categories focused on clinical, economic, quality of life, and other outcomes associated with clinical interventions. Most studies were retrospective analyses of administrative data such as hospital medical records and insurance claims. From the standpoint of AHRQ investigators, OER has affected some policies and practices. In the next decade, OER needs to provide more definitive answers to "what works" and accelerate the process by which research findings affect policy, practice, and outcomes, conclude the researchers.
See "The outcomes of outcomes and effectiveness research: Impacts and lessons from the first decade," by Drs. Stryer and Tunis, Ms. Hubbard, and Dr. Clancy, in the December 2000 Health Services Research 35(5), pp. 971-987.
Reprints (AHRQ Publication No. 01-R027) are available from the AHRQ Publications Clearinghouse.
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