Outcomes across the care continuum.

OBJECTIVES

This article focuses on issues facing scientists and clinicians in developing outcomes useful across the care continuum, particularly in examining the impact of care delivery systems.

METHODS

Research and current corporate examples of the continuum of care delivery and relevant outcomes were reviewed. Questions addressed included the following: How do we know when networks or care systems are successful? What are the clinical and financial indicators of system success? What are the indicators of declining performance?

RESULTS AND CONCLUSIONS

Approaches to describing program or system outcomes have included snapshots at single points in time, snapshots of system transitions, multiple snapshots (global indicators), and population-based outcomes. Crucial methodological issues include identification of severity and risk adjustment, access to usable data across settings, determination of the portion of an intervention to allocate to quality and cost outcomes, and integration of disease-specific, population-specific, and general outcome measures.