Outcomes Research and Practice Guidelines: Upstream Issues for Downstream Users

Abstract

With both the cost and quality of health care under scrutiny, many in the health care industry have turned to outcomes research and practice guidelines for answers. But many physicians have resisted, claiming their clinical judgment is a better guide. Both camps may be right.

The effect of technical support on clinician attitudes toward an outcome assessment instrument

“…As a result, documentation of the intent and the effects of treatment has become a major determinant of reimbursement eligibility, t°-12 Outcome assessment (OA) involves examining the progress of a patient's illness to determine whether treatment is having a positive effect. 13 As it also provides a means of uncovering and emphasizing those services that are of the greatest benefit to the patient] ° OA has emerged as a primary means of examining the quality of treatment in health care settings. OA is likewise rapidly becoming integral to the field of mental health service delivery,14 demonstrated by the proliferation of mental health OA instruments such as the Outcome Questionnaire 15 and the SF-12 Health Survey.…”

False dichotomies: EBM, clinical freedom, and the art of medicine

“…I believe this substantially overstates the potential for conflict, since there is widespread agreement about the significance of different confidence intervals. 26 Although it is true that judgments of acceptability can differ, we have already seen that such judgments do not interfere with decisions to cease clinical trials when the evidence points to serious problems.…”

“…Are they relying on sound reasons about a particular patient, or on arbitrary factors such as procedures learned as students but experienced subjectively as clinical judgment? (Gifford,26 pp 169-70). The extent to which clinical judgment is ''what clinicians say they are doing when they aren't able to do much more than guess'' (Gifford,26 p 168) remains unclear.…”

Innovating Medical Knowledge: Understanding Evidence-Based Medicine as a Socio-Medical Phenomenon

“…At minimum, this shift is signified by a change from a medical model grounded in basic science to a novel statistically-based medicine (Henry, 2006). EBM's hierarchy of evidence is at the service of outcomes research, which uses a cluster of statistical and epidemiological methods for analyzing the therapeutic effectiveness of clinical interventions (Gifford, 1996). This commitment to highly controlled data and methods of statistical analysis that were previously used only for population-based research (such as public health) represents not only methodological change, but also a novel regard of the reliability of various forms of medical knowledge.…”

“…For instance, rather than determining the properties that enable or hinder an intervention's success, randomized controlled trials establish efficacy by comparing the outcomes of the experimental arm with those found in a similar subject population receiving a comparator intervention. Eliminating bench science's focus on determining why a treatment works or not through appeal to deeper biological theory has certain advantages for healthcare decision-making (Ashcroft 2002;Gifford 1996). 5 Definitive biological explanation has not always led to safe or beneficial treatment of actual patients.…”