Introduction

1. Introduction weichu@episerv.cph.ntu.edu.tw outcome research

2. Aims: • To equip students with basic methodology and skills of clinical and preventive outcome research outcome research

3. Rules • Students: graduate students of the College of Public Health (CPH), NTU • Credit: elective, 2 credits (2 hours/week) • Time: 10:10-12:00am, Tuesday, 1st semester • Place: Room 205, New Site of CPH • Instructor: Wei-Chu Chie/Kuo-Liong Chien • Language: English/Chinese • Evaluation: class performance 10%, oral presentation 20%, written report 70% outcome research

4. * Dr. KL Chien outcome research

5. Outcome: importance/rationale • Impossible to ask how you grow, ask not what you harvest 只問耕耘不問收穫in preventive and clinical medicine • Location of outcome • in health care policy management • in clinical epidemiology & evidence-based medicine outcome research

6. Health care policy/management • Structure • Process • Outcome • Donnabedian, 1966 outcome research

7. Clinical epidemiology • The science of making predictions about individual patients by counting clinical events in similar patients, using strong scientific methods for studies of groups of patients to ensure that the predictions are accurate. • Fletcher, et al. 1996 outcome research

8. Clinical epidemiology • The study of variation in the outcome of illness and of the reasons for that variation: • observation • inference • Weiss, 1996 outcome research

9. Background of outcome research development • Health as basic human right • Rising health care cost/movements of cost containment • Managed care outcome research

10. Definition of an “outcome” • The end result of care, or a measurable change in the health status or behavior of patients. • Harris, 1991 outcome research

11. Health outcomes in clinical epidemiology • Death • Disease • Discomfort • Disability • Dissatisfaction • Fletcher et al., 1996 outcome research

12. Death • A bad outcome if “untimely” • Fletcher et al., 1996 • The final endpoint • insensitive sometimes • too late in preventive medicine outcome research

13. Disease • A set of symptoms, physical signs, and laboratory abnormalities • more objective? • surrogate endpoints • definition of “normal” outcome research

14. Discomfort • Symptoms such as pain, nausea, itching, and tinnitus • part of health status • part of quality of life • more subjective • usually needs measurement instruments: questionnaires or scales outcome research

15. Disability • Impaired ability to go about usual activities at home, work, or recreation • goal of tertiary prevention • specific definition and assessment tools • special domain of health status or quality of life outcome research

16. Dissatisfaction • Emotional reaction to disease and its care, such as sadness or anger • more subjective • part of quality of life • part of service satisfaction • more likely to be used in management outcome research

17. Outcomes in outcome management • Clinical • Functional • Financial • Perceptual • Hegyvary, 1991 outcome research

18. Clinical outcome • The patient’s response to medical and nursing intervention • wound healing, mobility • weight gain, body temperature • blood pressure, heart rate, blood sugar, peak expiratory flow outcome research

19. Functional outcome • The patient’s maintenance or improvement of physical functioning • specific: self-catheterization, … • global: overall sense of well-being • independent living skills: ADL, … • part of quality of life: specific and global outcome research

20. Financial outcome • Outcome achieved with the most efficient use of resources • direct cost • approximate cost: length of stay, frequency of ER visits • indirect cost • for cost-effectiveness analysis outcome research

21. Perceptual outcome • The patient’s satisfaction with outcomes, care received, and providers • new attention • more in management outcome research

22. Outcome of health education and health care intervention • Health behaviors • Self-efficacy • Health status • Health care utilization • Chronic diseases self-management program • Lorig et al., 1996 outcome research

23. Health behaviors • Primary prevention: • Exercise, diet, smoking, alcohol, … • Stress coping, injury prevention, ... • Immunization and chemoprophylaxis • Secondary prevention: screening • cancer • cardiovascular, … • Tertiary prevention • compliance, disease management and self-care outcome research

24. Self-efficacy • Confidence to perform certain behaviors • health behaviors • disease management • compliance and self-care • community participation outcome research

25. Health status • Well-being • Disability • physical • mental • social outcome research

26. Health care utilization • Visits • regular clinics: physical, mental • emergency • alternative medicine • Hospital stays • Outpatient surgeries outcome research

27. Multidisciplinary approaches • Teamwork • Key caregivers: nurses • Physicians of different clinical specialties • Management specialties • Statisticians • Epidemiologists outcome research

28. Benchmarking • Best practice • Comparison • between similar organizations or units • between the present outcome and the benchmark • Management purposes outcome research

29. Process of outcome management/research • Identifying the patient outcome • building the team • selecting the instrument • measuring the patient outcome • analyzing the data • summarizing the findings • applying the findings to practice • planning future patient outcomes projects outcome research

30. Outline of the course • Research design • Data source • Instrument selection and measurement • Different outcomes • Different procedures • Application to Evidence-based medicine outcome research