1996 OPEN FORUM Abstracts
How Can We Measure Outcomes?
Dean R. Hess, PhD, RRT Wednesday, November 6,1996
Desirable outcomes are those that add value. Value is the ratio of quality to cost. In other words, outcomes of value have a high quality relative to cost. The issue then becomes how to measure quality and cost.
Quality is defined by how well desired outcomes have been met. To define quality, measurable outcomes that describe quality must be defined. A study to evaluate quality is then designed, after which data are collected and analyzed, and conclusions are derived based on the data.
Appropriate outcomes to define quality can come from various sources. Personal experience should be avoided due to the bias inherent in anecdotal evidence. A literature review can be conducted. However, this can be an overwhelming task because the literature must be read and the weight of the evidence must be assessed. Clinical practice guidelines can be useful sources of outcomes measures.
Outcomes can be categorized related to physiologic changes morbidity, mortality, quality of life, satisfaction, and cost. It is often useful to evaluate outcomes in multiple categories. Physiologic outcomes are easy to measure and provide immediate feedback, but may have no relation to long-term outcomes. Increasingly, quality of life and patient satisfaction are recognized as important outcomes. Valid quality of life health surveys are available (e.g., the Medical Outcomes Study Health Survey SF-36). Dyspnea scoring systems (e.g., Borg Score) are used to evaluate the quality of life for patients with COPD.
When evaluating outcomes, it is important to control for the effect of acuity. Commonly used acuity scoring systems include APACHE and MedisGroups.
An important outcome is cost. When evaluating cost, it is important to recognize that charges should not be used as a proxy for costs. Direct cost should be evaluated, including capital expense, operational costs, repair costs, training costs and personnel costs.
"When you can measure what you are studying, and express it in numbers, you have advanced to the stage of science. When you cannot measure... your knowledge is of a meager and unsatisfactory kind." Lord Kelvin