Origins
The c. 1847 work of Ignaz Semmelweis on the association between puerperal fever and the absence of aseptic procedures (specifically, doctors who failed to clean their hands before delivering babies) and the subsequent use of calcium hypochlorite to reduce risk, is an early example of outcomes research. Semmelweis' results were not accepted until after his death, when the germ theory of infection became established.
Although the exact origins of the term "outcomes research" is unclear, the methods associated with outcomes research first gained wide attention in the 1850s as a result of the work of Florence Nightingale during the Crimean War. Nightingale studied death as her primary outcome, recording the cause of death, including wounds, infections, and other causes. The intervention - a combination of effective nursing, hygiene, better nutrition, reduced crowding - reduced mortality significantly. After returning to England, Nightingale studied variation in childbirth practices at home and at institutions and their effect on maternal mortality.
Both Semmelweis' and Nightingale's work were characterized by the continual gathering of detailed statistics.
Ernest Amory Codman, a Boston orthopedic surgeon, noted in 1914 that hospitals were reporting the number of patients treated but not how many patients benefited from treatment. At that point he argued that all hospitals should produce a report "showing nearly as possible what are the results of treatment obtained at different institutions." However, Codman's advocacy of disclosure of institutional data by hospitals has yet to be universally adopted: such disclosure occurs only after being legally mandated.
Around the beginning of the twentieth century, professional organizations and hospital authorities began to adopt a standard form of medical record. In the UK, this was also adopted in primary care. Standardized data recording meant that for the first time medical records could be used as a moderately reliable data base for research.
During World War I, intense efforts to improve the outcomes of care for battle casualties, with careful attention to outcomes led to major advances in orthopedic surgery, plastic surgery, blood transfusion and the prevention of tetanus and gangrene. There were also major advances in the organization of care and in record keeping. During World War II, the UK centralized many medical services: the resulting infrastructure was used as the basis of a National Health Service in 1948. Centralization facilitated the establishment of national and local databases.
Avedis Donabedian's 1966 paper "Evaluating the Quality of Medical Care" first used the term "outcome" as part of the framework of quality assessment. Archie Cochrane's 1971 Rock Carling Fellowship monograph Effectiveness and Efficiency: Random Reflections on Health Services clarified a number of key concepts in outcomes research and evidence-based medicine. John Wennberg's studies of variations of healthcare practice in the USA resulted in the publication of The Dartmouth Atlas of Health Care, which reports on healthcare usage and distribution within the USA. Wennberg described his methods in his book Tracking Medicine: A Researcher's Quest to Understand Heath Care.
Paul Ellwood's 1988 Shattuck Lecture coined the term "outcomes management" to describe a scenario where patient care would be driven by detailed analysis of how similar patients fared after alternative treatments. Carolyn Clancy and John Eisenberg's 1998 Science paper emphasized the importance of considering patients' experiences, preferences and values in outcome evaluation, as well as the needs of those who provide, organize and pay for healthcare, including the public.
Read more about this topic: Outcomes Research
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