Routine health outcomes measurement

Evidence-based practice describes a healthcare system in which evidence from published studies, often mediated by systematic reviews or processed into medical guidelines is incorporated into clinical practice. The flow of information is one way; from research to practice. However many interventions by health systems and treatments by their staff have never been, or cannot easily be, subject to research study. Of the rest, quite a lot is from research that is graded as low quality. All health staff intervene in their patients on the basis of both information from research evidence and from their own experience. The latter is personal, subjective and strongly influenced by stark instances which may not be representative. However, when information on these interventions and their outcomes are collected systematically it becomes "practice-based evidence" and can complement that from academic research. To date, such initiatives have been largely confined to primary care and rheumatology. An example of practice-based evidence is found in the evaluation of a simple intervention like a medication. Efficacy is the degree with which it can improve patients in randomised controlled trials– the epitome of evidence-based practice. Effectiveness is the degree with which the same drug improves patients in the uncontrolled hurly-burly of everyday practice; data which are much more difficult to come by. Routine health outcomes measurement has the potential to provide such evidence.

The information required for practice-based evidence is of three sorts: context (e.g. case mix), intervention (treatment) and outcomes (change). Some mental health services are developing a practice-based evidence culture with the routine measurement of clinical outcomes and creating behavioral health outcomes management programs.

There are many similar, overlapping definitions of health outcomes, all involving changes in health status. Some stipulate that the population or group has to be defined (different outcomes are expected for different people & conditions), whilst others specify that health outcomes are the result of interventions or their lack, rather than simply change over time. A strong example is that of Australia’s New South Wales Health Department: health outcome is

"change in the health of an individual, group of people or population which is attributable to an intervention or series of interventions"

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