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

Posted on RAND.org on January 01, 1994

by David Hadorn, David P. 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.

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