The outcomes movement and health status measures.

The outcomes movement is exemplified by clinical effectiveness studies incorporating patient-centered outcomes measures. Findings from these studies are used to base payment decisions and improve the structure and process of clinical practices. The usefulness of these studies is dependent upon the selection of appropriate outcomes measures. Typically, clinical measures used by health professionals are narrowly focused and assess physiologic, other biomedical, or limited functional dimensions of health. On the other hand, patient-centered outcome measures are more broadly defined and capture health status as perceived by the patient in areas of health identified to be of value to the patient. An introduction to multidimensional general and disease-specific health status measures is presented. Health status and other outcomes assessments should be part of a continuous quality improvement cycle which begins with measuring patient status and developing treatment plans, proceeds to monitoring patient progress, evaluates the clinical effectiveness of the service, and concludes with outcomes information being fed back to improve the structure and process of future health care services before the cycle can begin again.