Outcomes Measurement for Social Work Research and Practice in Health Care

Barbara Berkman, D.S.W., Director of Social Work Research and Quality Assessment, Massachusetts General Hospital and Associate Director, Geriatric Education Center, Harvard Medical School

The current evaluation movement in health care focuses attention on "Health-Related Quality of Life (HRQL) outcomes which reflect health professional practice as it actually exists, and not as in a strictly controlled clinical trial. In the past, health outcomes have been defined very narrowly, focusing primarily on traditional clinical indices that measured elements within the biological component of the biopsychosocial model. Currently, there is growing recognition of the need to go beyond traditional physiologic variables to focus on other components of quality of life, many of which are relevant to social work practice.

The question which must be addressed by social workers is the effectiveness of practice in terms of patient-centered outcomes. At this time, with existing knowledge, it is virtually impossible to determine the effects that social work services have, much less whether the effects are preferable to the outcomes that may have resulted from other services being given, or no services.

In evaluating the performance of social workers in health care, it is important to identify and measure outcomes for which social workers may reasonably be held accountable. Because the patient introduces variables that are often beyond the control of the social worker (such as severity of illness or comorbid conditions), outcome measurements must be selected which explicitly measure those dimensions of HRQL most relevant to the social work interventions under study. There are both conceptual and methodological issues which need to be considered in selecting outcome measures for their appropriateness for social work in health care.

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