Measuring Outcomes

Introduction

Outcome measurement can be defined various ways. One definition is “a measure of the quality of medical care, the standard against which the end result of an intervention is assessed.” Another definition is “the determination and evaluation of the results of an activity, plan, process or program and the comparison with the intended or projected results.” Although these definitions differ somewhat, both measure some level of care and both assess care against some standard, which then leads to the implementation of changes if the health intervention is found to be suboptimal. Outcome measures may be used by an individual physician to convey expected results to a patient or to evaluate his or her own results. Outcome measures also can be used to assess systems of care. Almost always, outcomes are measured to ensure that the results of care are optimal, or if not, to trigger strategies that will improve the outcome of interest.

Measuring outcomes dates back several centuries. During the Crimean War (1854), Florence Nightingale measured morbidity and mortality rates and related them to the quality of the nursing care given to wounded soldiers. She found that adequate care reduced the mortality rate by 32%. Early in the 20th century, Dr. Emory Groves suggested that guidelines for postoperative follow-up could reduce adverse outcomes. At The Massachusetts General Hospital in 1914, Dr. E.A. Codman prophetically recommended that the result of patient care should be used as an indicator of the quality of that care. Unfortunately, his progressive views met with resistance, and he was fired. Some 50 years later, Donabedian was the first person to refer to the three aspects of measuring quality in health care: structure, process, and outcome. He said that these three aspects were complementary and equally important.

During the past 20 years, greater emphasis has been placed on measuring and knowing outcomes, at either a system level or an individual level. The concept of value-based care, with value being defined by quality and cost, has come to affect both reimbursement and reputation, which makes measurement of outcomes an integral part of modern-day health care. This chapter is intended to introduce the field of outcome measurement; the concepts involved will be defined in general terms, and then some measures used to evaluate care given to patients with colorectal disease who are undergoing colorectal surgical procedures will be discussed.

Types of Outcome Measures