Outcomes Measurement: Health Care Outcomes - the Patient Point of View

John E. Ware, Jr., Ph.D., The Health Institute, New England Medical Center

Dr. Ware presents outcomes measurement in the context of managed care with specific reference to functional assessment in health and behavioral health. He advocates for adding information about the public's experience of social interventions as part of the database in addition to the traditional economic information that is used in decision making.

He warns that in the absence of any information to the contrary decisions regarding health care restructing will continue to be made on the basis of economic data, and the success of health care reform will largely be based on its success in reducing medical expenditures in the absence of evidence to the contrary. Because of this, good information must be added to the database upon which health care decisions are based for purposes of understanding in much broader terms what health care systems are doing to people in their everyday lives.

He discusses future challenges to patient-based outcomes measurement including: more efficient questionnaires; increased compehensiveness of normative surveys; greater comparability of concepts and methods across applications; advances in technologies for collecting and processing data; longitudinal monitoring of general and specific populations; and improved systems for linking datasets. He anticipates much more efficient questionnaires, including shorter forms; increased comprehensiveness and increased standardization across applications; new technologies such as scanning and fax systems producing assessments and results in a matter of seconds; longitudinal monitoring; linkning of databases. He sees the linking of the clinical, physical, social role, and generic database with economic database as revolutionizing the evaluation of health care services in the country. He urges the field to avoid oversimplification of outcomes measurement.

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