Outcomes research and otolaryngology.

Outcomes research studies the effects of diverse therapies on patient outcome and is increasingly recognized by physicians, third-party payers, and the federal government as crucial for the demonstration of treatment effectiveness and the establishment of patient treatment guidelines. Outcomes research began in the 1970s when researchers studied the geographic variation in the rates and appropriateness of various surgical procedures, including tonsillectomies. Outcomes research is different from traditional clinical research because it addresses a wide variety of issues pertaining to health care delivery, strategy, and policy. To address these issues, outcomes research uses two principal methodologic approaches: (1) nonrandomized research methods and (2) expanded descriptions of patient outcomes. The methodologic requirements for outcomes research include (1) establishment of the diagnostic criteria for the disease under study, (2) creation of clinical-severity index for prognostic stratification, (3) identification and measurement of cogent comorbid conditions, and (4) establishment of outcomes that include descriptions of health status, quality of life, satisfaction with care, and medical costs. Many diseases within otolaryngology seem appropriate for outcomes research. Because prospective outcomes research is conducted with patients treated in the community, great opportunity exists for community-based physicians to become involved in this type of research.