already exist. The cowboys and cows go to Abilene because they have an incentive to do so. We need to create a similar pull in clinical research today.

Next we are going to hear from Lou Sherwood from Merck and Co. about disease management and the importance of outcomes research. Myrl Weinberg will also discuss the idea of integrated patient-centered care. There is a changing relationship between patients and their healthcare providers that necessitates a more integral role for patients at every step of the decision making process. This is just one of many things that must be considered when rethinking the process by which health care decisions are made and implemented so as to improve the health of the country.

OUTCOMES RESEARCH AND DISEASE MANAGEMENT

Lou Sherwood, M.D.

Senior Vice President for Medical and Scientific Affairs

Merck and Company

The second frontier is getting physicians to practice evidence-based medicine (setting care objectives, collecting data, and being accountable for the results). We need a great deal of additional research to figure out how to do all of this optimally. The thousands of Continuing Medical Education lectures delivered every year in academic institutions and by the pharmaceutical industry do not accomplish the goal of reaching the second frontier. That goal involves starting with outcomes research and moving to disease management. Outcomes research examines the consequences of medical treatment that are noticeable to patients and their families. It includes typical dichotomous variables, such as whether people live or die, and the so-called humanistic outcomes such as quality of life, functional status, and patient satisfaction—things that are vitally important to patients and their families. The third variable is the associated costs.

The thousands of Continuing Medical Education lectures delivered every year in academic institutions and by the pharmaceutical industry do not accomplish the goal of reaching the second frontier.

—Lou Sherwood

Why do we want to measure outcomes? It is important to do so because people are beginning to look critically and measure what various products and their organizations do in relation to health care. In light of the consolidation of health care and the changes being made, it is critically important that these measures be examined. We must have a structure, look at process, measure outcomes, and try to continually improve what we do.

What is meant by structure, process, and outcome? If patients’ risk factors are not being addressed in a secondary prevention mode (the things that we



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