Contents
Conference Report: Medical Outcomes Trust Conference Presents

Building an Integrated, Hospital Based Outcomes Research Program

Outcomes Research and Disease Management Come to State Medicaid Programs

At the Trust's 1997 Annual Conference I gave a short address on the "State-of-the-Outcomes Field" in which I indicated, with some disappointment, that although the acceptance of the concept of routine functional outcomes measurement had ascended to two-thirds of the medical services system, the actual implementation remained at the 1% to 2% level.

Up until two years ago the functional health assessment field had been driven largely by social scientists who were developing new instruments for functional status assessment, individual health services researchers and clinical investigators, pharmaceutical companies interested in clinical trials of new pharmaceuticals, and by the grant programs of the Agency for Health Care Policy and Research. Practicing physicians and their professional organizations were indifferent at best.

However, in recent years a new force propelling the adoption of functional health measures has appeared generated largely by widespread concern about quality of care, the tradeoff between cost restraint and quality, value assessments, accountability and equity. A federal agency, the Health Care Financing Administration, assumed a leading role by mandating that all managed care organizations offering services to Medicare recipients measure functional status and well-being on a regular basis as a prerequisite for receiving Medicare approval and reimbursement.

Then, within the last year or two, three key national acrediting bodies initiated processes that require the regular collection of functional status and well-being data from patients in order to qualify for accreditation. The organizations are the Joint Commission on Accreditation of Health Care Organizations, the National Committee for Quality Assurance, and the American Medical Association.

In a remarkable signal of new collaboration, the three organizations formed a jointly sponsored Performance Measurement Coordinating Council to work toward common measurements and standardization across their accrediting requirements. Each of the three accrediting bodies reported on their progress at the Medical Outcomes Trust annual conference last November. The joint effort in accreditation and standardization that will permit outcomes scores be used for multiple purposes across the requirements of multiple organizations is a great leap forward in the outcomes assessment field. As a result, just in the last year there appears to have developed a surge of interest in the outcomes field. We felt that surge at the Medical Outcomes Trust Annual State-of-the-Art Conference held in Boston, November 2, 1998. The entire Conference was captured on audio tape at the request of the Joint Commission on Accreditation of Health Care Organizations. Louise Kaegi, the Consulting Editor of the Joint Commission's Journal on Quality Improvement, and since then also Executive Editor of the Joint Commission's Benchmark, edited the transcripts. The transcripts have now been published in their entirety in the Journal on Quality Improvement, Vol. 25, No. 5, April, 1999. With the consent of the Joint Commission on Accreditation of Health Care Organizations the Trust is reprinting the Journal article in this issue of the Monitor. The impact of the accrediting organizations' interest in routine outcomes assessment has already been substantial and promises to be even more forceful in years to come.

Other developments also have promise for propelling the outcomes assessment field to higher levels of usefulness. One of these developments is the practical application of item response theory and computer adaptation to the measurement of functional status and well-being. This new technology elevates the precision of measurement of functional status and well-being to levels that permit application for monitoring individual patients and adjusting their treatments accordingly. Prior to the development of these new systems the fixed length and fixed format, largely pencil and paper surveys, allowed the use of the measurements primarily for group comparison rather than for individual monitoring. That limitation, I believe, has been a major factor in limiting physicians' adoption of functional health measurement. This new technology was described at the Trusts 1998 Conference, and will be updated at the Trusts' upcoming State-of-the-Art conference in Baltimore, October 24-25, 1999.

In this issue of the Monitor we are including a letter to the Trust from the American College for Medical Quality and its President, Alex Rodriguez, M.D. The College is seeking greater interaction and cooperation among the multitude of professional organizations that have been formed around issues related to quality of medical care. We suspect that such initiatives will help achieve standardization and greater cost effectiveness in the use of technology for quality improvement, and could possibly add further momentum to the adoption of health status assessment in routine clinical practice.

Alvin R. Tarlov

President