In 1989, Congress enacted PL. 101-239, establishing the Agency for Health Care Policy and Research (AHCPR). Since then, practically every specialty society has developed practice guidelines for its practitioners, and every health care organization has embarked on some outcomes research. Outcomes research has become a fashion, meaning all things to all people, and runs the risk of becoming meaningless. This article attempts to reduce the confusion by clarifying what outcomes research is and delineating its several levels, along with the methods, tools, and examples appropriate to each level. The contributions of outcomes research to health care delivery innovation to date have been modest. Ultimately, we need community health information systems, which have not only the structural and process variables but also include the outcome results, to guide decision making with regard to the health of entire communities and the appropriate investment of resources to improve health.
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