Policy implications of outcomes research.

This article was acceptedfOr publication September 3, 1996 W e all hear about the need for information on what kind of care is worth providing in terms of both costs and final results for the patient. Outcomes research is receiving much attention now because it is expected to fill this information gap. Occupational therapists, like other health care professionals, are in the midst of either contributing data to a large data bank that will be used to generate outcomes data or conducting outcomes research themselves. Outcomes research will playa major role in health care policy as well as in direct clinical decision making. But the health policy questions being asked make it apparent that Outcomes data are not easily applied. The eagerness to use outcomes can outpace the availability of data and is raising many policy questions about how the data should be used. This article presents an overview of how outcomes data are being used in health policy making and the questions they raise. Defined comprehensively, outcomes of care can include the usual mortality and morbidity outcomes as well as quality of life, physical functioning, and mental and emotional status. Outcomes can be complex in definition because treatment orren affects patients along a time continuum, from the relatively short term to the very long term. Outcomes research links these short-term and longterm outcomes with the type of care that patients with a particular health condition receive. The purpose of outcomes research is to identify what works best for which patients (Guadagnoli & McNeil, 1994). What makes outcomes research unique and distinguishes it from clinical trials is that outcomes research examines the effectiveness of treatment as it is administered under real-life circumstances, where patients as well as the treatment itself are likely to have some variances. For example, in real life, patients may not take medications exactly as scheduled or may not do exercises specifically as recommended, and a number of therapists can provide therapy. In contrast, clinical studies examine the potential benefit of a treatment under relatively ideal circumstances, with strict adherence to the treatment protocol and a tightly defined patient population. Outcomes studies typically attempt to include a cross section of patients with a given health condition who receive either alternative treatment modalities or a single treatment modality. Patients who have the same health condition may differ from each other in ways that could have a bearing on the effectiveness of treatment, including gender, age, comorbidities, social background, and economIC status. The current level of interest in outcomes research is heightened by the possibility that it will provide a wealth