ABSTRACT
The belief that American medicine is ineffective as well as costly has produced a "third revolution" in health care (Relman, 1988). Patients and payers increasingly subscribe to "waste theory" (Mehlman, 1986)—according to which uninformed physicians squander health care dollars on unenlightening diagnostic tests and unproductive medical treatments-and demand that doctors be apprised of what does and does not work. This attention to medical outcomes, as opposed to, say, inputs, has coalesced into a veritable "movement" (Epstein, 1990) whose tenets are as follows: that the outcomes of health care have not received sufficient attention, that physicians know too little about what produces desired health effects, and that the conduct and communication of outcomes research will remedy this situation, thereby containing costs and ensuring quality.1
