Clinical outcomes research: the international perspective

The decade of the 1990s has seen worldwide emphasis on the containment of healthcare costs. Much of the limitation of cost has been carried out at the perceived potential decrement in the quality and outcome of the delivery of patient care. This concern has not been limited to countries with traditional indemnified insurance (USA) or the more social based healthcare programs of the European countries and Canada. As physicians, we have not effectively utilized research methodology in establishing which therapeutic interventions are both cost effective and beneficial. A concerted worldwide effort by clinicians of all disciplines will be necessary to effect cost reduction and improved outcomes.