Outcomes research in respiratory care

Outcomes research seeks to understand the end results of particular health care interventions. End results include effects that people experience and care about, such as change in ability to function. The modern outcomes movement in the United States had its beginnings in the early 1980s, with an official start when Congress created the Agency for Health Care Policy and Research in 1989. Today known as the Agency for Healthcare Research and Quality, this agency supports outcomes research that is designed to answer 4 questions: (1) What works? (2) What doesn't? (3) When in the course of illness does it work or not? and (4) At what cost? Outcomes research provides the data for evidence-based medicine. Both activities work together in a continuous quality improvement cycle under the general heading of disease management. Outcomes research includes such things as epidemiology studies, clinical trials (designed as effectiveness studies), quality of life surveys, and cost analyses. Outcomes research is distinguished from traditional clinical research more by its focus than its methods. For example, outcomes research is population-centered rather than disease-centered, deals more with processes of care than drugs and devices, and relies less on the "hard sciences" such as physics and biochemistry and more on the social sciences such as economics, behavioral sciences, and epidemiology. Appropriate outcomes measures may be classified as (A) clinical, such as physiologic measures and mortality; (B) economic, such as direct and indirect costs of care; or (C) humanistic, such as quality of life and patient satisfaction with care. Respiratory therapists need to be familiar with outcomes research issues in order to be educated consumers of (and to participate in) future studies.