PARADIGM FOR THE MANAGEMENT OF PATIENT OUTCOMES

Health-status measurement is discussed, and a paradigm for the management of patient outcomes is described and applied to a patient case. Challenged not only to eradicate disease but to improve health, today's health-care professionals must examine the structure, process, and outcomes of care to ensure that optimal care is provided. Techniques for measuring outcomes have been developed; important indicators are functional status, general well-being, and the patient's assessment of care. An interdisciplinary team of physicians, social scientists, and public policy experts at The Health Institute, New England Medical Center, Boston, Massachusetts, studies ways of monitoring and improving the quality and efficiency of care. The team, which now includes a pharmacist, is working to develop practical systems of care whose outcomes can be tested in patients at the medical center. The paradigm developed for the management of patient outcomes begins with evaluation based on results of history, physical examination, and diagnostic tests. Problems and goals (therapeutic endpoints) are then defined, and the safest, most effective, and least costly treatment is selected. Treatment is monitored for subjective and objective results and adjusted as necessary. The achievement of each endpoint contributes to improvement of the patient's health. Knowledge of health-status measurement will enable pharmacists to increase their contribution to patients' health.