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OCR for page 224
26
Gaining Acceptance for
Effectiveness and Outcomes Research
John D. Stobo
Effectiveness research has come a long way in terms of developing mea-
surement scales that are reliable, somewhat easy to obtain, and pertinent. It
is clear to me that further research in effectiveness and outcomes clearly
needs to be done. It needs to be done, in my mind, for two reasons.
REASONS FOR PURSUING RESEARCH
First, as a profession, we physicians should be committed to providing
the highest quality of care to our patients. Effectiveness and outcomes
research will affect the question of quality and provide a rationale for deciding
what the highest quality care is.
Second, it will provide a rationale for discussing the cost of health care.
Like Henry Aaron (1), I am not convinced that outcomes research will
substantially decrease the cost of health care. Nevertheless, it clearly will
rationalize discussions of what is appropriate health care and what is not.
The caution of Henry Aaron and others echoes the good advice that Holly
Smith, my previous mentor and Chief of Medicine at the University of
California at San Francisco, gave me: "Never promise more than you can
give, and always give more than you can promise." Do not promise that
outcomes research will significantly lower the cost of health care.
WHO MUST BE CONVINCED?
My concern is that effectiveness research be accepted by other groups
who must be involved in it, of which there are three. First are the payers. I
do not foresee any problem there. I think the payers of health care are
thirsty for this information and will readily accept it.
224
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WlIERE DO WE GO FROM HERE?
225
The second group is the recipients of health care. Here, I think, is a
major challenge: to provide the results of outcomes and effectiveness research
to those individuals. A significant impact on cost can be achieved by
educating recipients of care about utilization.
The last group that is crucial to outcomes research represents the biggest
challenge. This is the providers of health care, particularly physicians. At
my institution, Johns Hopkins, there is a lot of discussion about research
into quality of care, effectiveness of care, outcomes of care, but it is done
by a relatively small number of individuals. The majority of the faculty
have not bought into outcomes research.
What will it take to get providers of care to accept this type of research?
Again, I agree with others that there is going to be a pull and push phenomenon
here. I think the pull will have to come from the persons who are already
convinced of the value of outcomes research. Physicians have to buy into
it. This is evident from the study of the Harvard Community Health Plan
(2~. Physicians have to be involved early on in these studies; they have to
feel some ownership of them so that they are not always in a reacting mode.
It is important to train physicians in methodologies that are used in out-
comes research. Most physicians, like myself, have been trained in areas
related to biomedical research and are not conversant with methodologies
that are important for carrying out and understanding other types of research.
A major effort should be made to educate physicians about the methodology
and interpretations of outcomes research.
WHO WILL PUSH FOR RESEARCH?
The push phenomenon is going to come from several areas, three in
particular. One is the government: this prodding by the Health Care Financing
Administration is important. There will be a push from employers. They,
because of an interest in cost of care and also, I hope, because of an interest
in quality of care for their employees, will be interested in effectiveness and
outcomes research. Employers may push their employees in the direction
of institutions that can document that they are as good as they say they are.
Finally, the push will come from hospitals, probably because they are
being pressured by the government and by employers. Hospitals will pres-
sure influential individuals to adopt practices that have been documented to
provide the most effective care and the best outcomes.
Four years ago, effectiveness and outcomes research was an area that
was completely foreign to me. It is one I have become interested in over
the last two years and one I have become very excited about. It is going to
be critical for American medicine in the future- and we are fortunate that
there are such good people doing such good work in this area.
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EFFECTIVENESS AND OUTCOMES IN HEALTH CARE
REFERENCES
1. Aaron, H.J. The Need for Reasonable Expectations. Pp. 215-217 in Electiveness
and Outcomes in Health Care. Heithoff, K.A. and Lohr, K.N., eds. Washington,
D.C.: National Academy Press.
2. Schoenbaum, S.C. An Attempt to Manage Variation in Obstetrical Practice.
Pp. 190-200 in Effectiveness and Outcomes in Health Care. Heithoff, K.A. and Lohr,
K.N., eds. Washington, D.C.: National Academy Press, 1990.
Representative terms from entire chapter:
henry aaron
