Making Judgments About Treatment Effectiveness Based on Health Outcomes

Theoretical and Practical Issues

Published In: The Joint Commission Journal on Quality Improvement, v. 20, no. 10, Oct. 1994, p. 547-554

by David Hadorn, David William Baker, Kathleen A. Dracup, Bertram Pitt

One of the major responsibilities of the 16-member panel charged by AHCPR with developing a guideline for the management of patients with heart failure was to determine the health care outcomes that are important and relevant to the development of clinical practice recommendations and the evaluation of patients' responses to treatment. The panel first determined that outcomes are those experienced directly by patients--i.e., mortality and health-related quality of life. In addition, they determined that changes in, and responses to, treatment should be guided by signs and symptoms rather than test results (e.g., not by the measurement of left ventricular function). Health-related quality of life can best be assessed by patient self-report, and the validity of these reports can be enhanced by using standardized instruments or by incorporating questions from such instruments into the history portion of patient evaluation. Panelists noted that physical examination and exercise testing could supplement patient reports.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.