Clinical practice and patients' health status: how are the two related?

Now that we have the ability to measure patients' health outcomes, physicians and health care systems need to know how to manage these outcomes. What are the causal pathways that link clinical and health status concepts? What are the key points at which physicians and health care systems can intervene in effective and cost-effective ways? We have argued that the elegant biomedical model that physicians use to understand disease is a blunt tool in the dissection of illness and that valid, reliable, and richly descriptive measures of HRQL fail at clinical tasks because causal linkages between clinical processes and health status outcomes have not yet been made convincingly, at either the conceptual or the empiric level. One approach to this problem is to develop and test causal models that explore the relationships among different measures of health status in an attempt to elucidate the "genesis" and "pathogenesis" of disorders of HRQL. Once physicians and health care systems know more about the determinants of poor health status and the mechanisms by which it occurs, creative attempts to intervene at multiple points in a causal pathway may be possible, making outcomes management a more realistic goal.