Outcomes research: science and action

Abstract

Outcomes research, which investigates the outcomes of health care practices, is intended to provide scientific evidence for clinical decision making and health care. This paper elucidates the goal and domains of outcomes research. Also it shows the potential and promise of outcomes research to provide a methodology to uncover what to do and how to do it, and enable the health care profession to achieve the right care, for the right patient, at the right time, the first time, every time, nothing more, and nothing less. Clinical caseA 56 year-old male smoker presented to a hospital emergency department, having suffered 3 h of severe chest pain. Physical exam showed a heart rate of 90 beats/min, blood pressure of 90/60 mmHg, and bibasilar rales. An electrocardiogram performed within 10 min of arrival demonstrated a 2-mm ST-elevation in leads V 1 -V 4 (Fig. 1). The patient was treated with 325 mg of aspirin, 600 mg of clopidogrel, and 4 000 U of heparin, and underwent primary percutaneous coronary intervention using right radial artery access. Following aspiration thrombectomy, a drug-eluting stent was placed in the left anterior descending artery, restoring normal blood flow. The door-to-balloon time was 70 min. Echocardiography showed a preserved left ventricular ejection fraction of 60% with only mild anterior-apical hypokinesis. He was started on 50 mg of metoprolol twice daily, 40 mg of atorvastatin daily, 81 mg of aspirin daily, and 75 mg of clopidogrel daily, and discharged from hospital on Day 3. Was this high-quality patient care?The care provided in the emergency department, cardiac catheterization lab, and coronary care unit was appropriate and excellent. However, despite rapid diagnosis and treatment for this patient with ST-elevation myocardial infarction, what were the long-term patient outcomes at 30 d, 6 months, and 1 year? While long-term survival free from recurrent major adverse cardiovascular events depends on the door-to-balloon time and type of drug-eluting stent, it also depends on the patient's ability to adhere to medication schedules, to follow up with his or her physician, to change his lifestyle, including smoking cessation, diet, and exercise, and to access and pay for health care services and secondary prevention.

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