Until recently, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has relied on structure measures in drafting their annual Hospital Standards for Accreditation Manual. Peer Review Organizations (PROs), on the other hand, relied on process indicators in evaluating quality of care provided to Medicare patients. Currently, however, a new movement called 'outcomes management' is evolving to include a number of areas that impact on the quality of patient care. It focuses on using outcome measures to manage quality. This trend toward outcome management is driven by economics and, to a lesser extent, by the curiosity of providers and researchers. In this paper the concept of outcomes management is presented, along with the objectives, the methods for implementation, and its relationship to quality improvement.
Get full access to this article
View all access options for this article.
References
1.
Al-Assaf A. F (1993). Outcome Management and Total Quality. In: The Textbook of Total Quality in Health Care. ( A F Al-Assaf and J A Schmele, eds). Delray Beach, Florida: St Lucie Press
2.
Al-Assaf A. F and Schmele J.A. (1993). The Textbook of Total Quality in Health Care. Delray Beach, Florida: St Lucie Press
3.
Batalden P.B., Nelson E.C. and Roberts J.S. (1994). Linking Outcomes Measurment to Continual Improvements: The serial 'V' Way of Thinking About Improving Clinical Care. The Joint Commission Journal on Quality Improvement;20 (4), 167-181
4.
Bohr D. and Bader B. (1991). Medical Practice Guidelines: What They Are and How They're Used. The Quality Letter; 3 (1), 1
5.
Bunker J.P., Forrest W.H., Jr, Mosteller F.I. and Vandam L.D. (1969). The National Halothane Study: A Study of the Possible Association Between Halothane Anesthesia and Postoperative Hepatic Necrosis . Bethesda, Maryland: NIH
6.
Codman E.A. (1914). The Product of a Hospital. Surg Gynecol Obstet;18, 491-94
7.
Coffey R.J., Richard J.S. et al (1992). An Introduction to Critical Paths. Quality Management in Health Care;1 (1), 45-54
8.
Cretin S. and Worthman L. (1986). Alternative System in Case Mix Classification in Health Care Financing. Santa Monica, California: RANND Corporation
9.
Donabedian A. (1966). Evaluating the Quality of Medical Care. Milbank Memorial Fund Quarterly;44, 194-196
10.
Donabedian A. (1988). The Quality of Care. JAMA; 260 (12), 1743-48
11.
Ellwood P.M., Huber M.R. and Couch J.B. (1991). The Future: Clinical Outcomes Managament in Health Care Quality Management for the 21st Century. Tampa, Florida : American College of Physicians Executives Press
12.
Ellwood P.M. (1988). Outcomes Management: A Technology of Experience . N EngJ Med;318 (23), 1549-56
13.
Ellwood P.M. (1992). Outcomes Management; The Impetus and Impact. Health Systems Review;25 (1), 24-26
14.
Epstein A. (1990). The Outcomes Movement - Will It Get Us Where We Want To Go? N Eng J Med;323, 266-70
15.
Farr W. ( 1975). Vital Statistics: A Memorial Volume of Selections from the Reports and Writings of William Farr. Metuchen, New Jersey: Scarecrow Press
16.
Flood A.B., Scott W.R., Ewy W. and others (1982). Effectiveness in Professional Organizations on the Quality of Care in Hospitals. Health Services Research ; 17 (4), 341-66
17.
Flood A.B., Scott W.R. and Ewy W. (1984a). Does Practice Make Perfect? Part I. Medical Care; 22 (2), 115-25
18.
Geehr E.C. (1989). Selecting a Proprietary Severity of Illness System . Tampa, Florida: American College of Physicians Executives Press
19.
Geehr E.C. (1992). The Search for What Works. Healthcare Forum Journal; 35 (4), 28-33Groves E.W. (1908). A Plea for Uniform Registration of Operation Results . BMJ; 2, 1008-9
20.
Health Care Financing Administration (1986 ). Medicare Mortality Information 1986. Vols I-VII. Washington DC: DHHS
21.
Hornbrook M. (1982). Hospital Case Mix: Its Definition, Measurement and Use: Part II. Review of Alternative Measures. Medical Care Review; 39 (2), 73-123
22.
Jcaho (1994). The Accreditation Manual for Hospitals. Chicago: JCAHO
23.
Jenks S.F. and Wilensky G.R. (1992). The Health Care Quality Improvement Initiative: A New Approach to Quality Assurance in Medicare. JAMA;268 (7), 900-918
Lezzoni L.I. (1989). Measuring Severity of Illness and Case Mix. In: Providing Quality of Care: The Challenge to Physicians (N Goldfield and D Nash, eds)Philadelphia: American College of Physicians
26.
Lezzoni L.I. and Moskowitz M.A. (1988). A Clinical Assessment of MedisGroups. JAMA;260 (1), 3159-63
27.
Linder J. (1991). Outcomes Measurement: Compliance Tool or Strategic Initiative. Health Care Management Review;16 (4), 21-31
28.
Linder J. (1992). Outcomes Measurement in Hospitals: Can the System Change the Organization? Hospital and Health Services Administration;37 (2), 143-166
Longo D., Bohr D., Miller L. and Miller J. (1990). Inventory of External Data Demands Placed on Hospitals . Chicago: Hospital Research and Educational Trust
31.
Luft H.S. and Hunt S.S. (1986). Evaluating Individual Hospital Quality Through Outcome Statistics. JAMA;255 (20), 2780-84
32.
Luft H.S., Bunker J.P. and Enthoven A.C. (1979). Should Operations be Regionalised: The Empirical Relation between Surgical Volume and Mortality. N Eng J Med;301 (6), 1364-69
33.
Markson L., Nash D., Louis D. and Gonnella J. (1991). Clinical Outcomes Management and Disease Staging . Evaluation and the Health Professions;14 (2), 201-27
34.
Meltzer R. (1992). The Hazards of Outcome Measures. Administrative Radiology;11 (1), 51-52
35.
Moses L.E. and Mosteller F. (1968). Institutional Differences in Postoperative Death Rates: Commentary on Some of the Findings of the National Halothane Study . JAMA;203 (7), 150-52
36.
Nash D. and Goldfield N. (1989). Information Needs of Purchasers. In: Providing Quality of Care: The Challenge to Physrcians (N Goldfield and D Nash, eds)Philadelphia: American College of Physicians
37.
Nash D.B. and Markson L.E. (1991). Emerging Trends in Outcomes Management. Frontiers of Health Services Management;8 (2), 3-52
38.
Nelson E.C., Larson C.O., Hays R.D., Nelson S.A., Ward D. and Batalden P.B. (1992). The Physician and Employee Judgement System: Reliability and Validity of the Hospital Quality Measurement Method. Quality Review Bulletin;18 (9), 284-292
39.
Nightingale F. (1859). Notes on Hospitals. London : John W Parder and Sons
40.
O'Leary D.S. (1987). The Joint Commission Agenda for Change. Chicago: JCAHO
Roberts J.S. (1994). Linking Outcomes Measurement to Continual Improvement: The Serial 'V' Way of Thinking About Improving Clinical Care. The Joint Commission Journal on Quality Improvement;20 (4), 167-181
43.
Roemer M.R. and Friedman J.W. (1971). Doctors in Hospitals: Medical Staff Organization and Hospital Performance. Baltimore: John Hopkins
44.
Shortell S.M. and L P. (1981). Hospital Medical Staff Organization and Quality of Care: Results for Myocardial Infarction and Appendectomy. Medical Care; 19 (1), 104-54
45.
Stewart A.L. and Ware J.E. Jr (1992). Measuring Functioning and Well Being. Durham, North Carolina: Duke University Press
46.
Thomas J.W. and Longo D.L. (1990). Application of Severity Measurement Systems for Hospital Quality Management. Hospital and Health Services Administration;35 (2) 221-43
