ABSTRACT
Surgeons have long been interested in using outcomes to measure quality of care. At the turn of the century, Ernest Amorv Codman, a prominent Boston sur geon and founder of the American College of Surgeons, promoted the idea that “the end result” of care, as assessed by long-term follow-up of patients, could be used to reflect the quality of care provided at different hospitals.3 4 Eight decades later, the emphasis on outcomes and quality improvement has evolved from several converg ing streams.5 First, the need for cost-containment stimulated efforts to identify inef fective interventions in order to eliminate unnecessary spending. As well, the cost-containment environment fostered the development of methods of measuring quality in order to ensure that it did not decline as costs were cut. Second, the documentation that significant regional variations existed in the use of medical pro cedures focused attention on the health outcomes associated with the different rates o f utilization.6 Third, the existence of large, computerized databases and of sophis ticated data handling capacities enabled the analysis of aspects o f care for literally hundreds o f thousands of patients. Finally, the recognition that functionally-based outcomes and quality of life measures are important in judging the effectiveness of an intervention also contributed to the growth of the outcomes movement.
