Health outcomes research: its influence on clinical decision making and the development of new imaging technologies.

The decade of the 1980s brought forth a significant number of profound changes in the manner in which health care goods and services are provided to the U.S. population. In 1983, Congress established the Prospective Payment System (PPS), which radically altered the manner in which hospitals were reimbursed for treating Medicare patients . By the end of the decade, Congress established a new fee schedule, to be implemented in 1992, under which all physicians ' services for Medicare patients were to be paid. This was known as the Relative Value Scale (RVS). In between, the federal government and, in particular, the Health Care Financing Administration (HCFA) implemented additional policy changes that, while not as dramatic as either the PPS or the RVS, significantly affected the delivery of health care to the American people. The decade of the 1990s is beginning with a new policy initiative, known as "outcomes research ," which may prove to be every inch as important, if r)Ot more so, than the earlier initiatives of the 80s. Also referred to as "patient outcomes research," "appropriateness studies," or "effectiveness initiative," the general thrust of outcomes research is to provide both the physician and the patient with improved clinical information about the expected or potential outcomes of various medical or surgical interventions in the treatment of illness. Some have referred to health outcomes research as the