ABSTRACT
Outcome measures assess the effects of health care on the health status of patients (Donabedian, 1988). Although the documentation of outcome measures such as mortality has long history, modern outcome assessment was not established until the 1970s as the result of at least three factors (Epstein, 1990; O’Connor and Neumann, 2006). First and perhaps most signifi cant was the perception of variation in clinical processes from doctor to doctor, hospital to hospital, and region to region. This variation raised questions about the quality of health care, and measuring health outcomes was seen as one way to answer these questions (Epstein, 1990; Kassirer, 1993). A second contributing factor was the infl uence of cost containment on quality. The growth of managed care and the emphasis on effi ciency led to concerns about the negative effect this might have on health care quality. Outcomes measures were seen as one way to monitor possible deterioration in the system (Epstein, 1990). Third, heightened competition among insurers also led to the perceived need for outcome measures that provide a metric of value for different health care plans. Although price plays a key role in this competition, buyers were and still are interested in the relative value of the health care they purchase.
