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10 - Health Outcomes

A Comprehensive Approach

from Part II - Rethinking Research

Published online by Cambridge University Press:  13 March 2025

Karen B. Schmaling  and
Robert M. Kaplan
Karen B. Schmaling
Affiliation:
Washington State University
Robert M. Kaplan
Affiliation:
Stanford University
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Summary

We use healthcare in an effort to live longer or feel better. Yet many evaluations do not consider these outcomes, which are of high importance to patients. Instead, they concentrate on variables that are considered surrogates for what treatment is attempting to achieve. Prevention of heart disease, for example, might be estimated from changes in LDL cholesterol levels. These surrogate markers are often poorly correlated with the outcomes of most importance to patients. Understanding the basic biological mechanisms is valuable, but sometimes irrelevant. The chapter reviews patient-reported outcomes that are becoming more commonly used to evaluate health care. These measures are used to create indexes that combine how long people live with the quality of life during the years that precede death. The measures are generic and can be used to compare the value of investing in interventions that have different specific objectives. Cost-effectiveness analysis can directly compare health gain associated with treatments as different as exercise training versus organ transplantation. The public policy implications associated with these metrics are discussed.

Keywords

outcomespatient-centeredQALYquality of lifesurrogate markers
Type
Chapter
Information
Rethinking Clinical Research
Methodology and Ethics
 , pp. 201 - 216
Publisher: Cambridge University Press
Print publication year: 2025

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