Information Needs Associated with the Changing Organization and Delivery of Health Care: Summary of Perceptions, Activities, Key Gaps, and Priorities. 1. Appropriateness of Care and Clinical Outcomes

04/30/1997

A key set of outcomes-related concerns has to do with how to interpret practice. For example, is a C-section rate too high or too low when it falls or is below average? Some standard for comparison or form of analysis is needed to interpret change. For example, if care processes are subject to strict clinical and utilization management oversight is this appropriate or too restrictive? That is, what is the relationship between care process and outcome? When is medical practice becoming more appropriate of efficient, and when is needed access being denied? Change threatens historical expectations and established practice. Each stakeholder is affected and these effects influence funding streams. Sorting out efficiency from eroding quality becomes critical to a public policy debate involving all stakeholders and a substantial portion of the Gross Domestic Product. Without better and more comprehensive measures of appropriate care and cost-effective care, it will be difficult to address these questions and to separate out individual interests from broader public policy concerns.

Just having outcome information is another concern. What are the outcomes and how much does each cost? How can they be compared on a risk-adjusted basis so health plans or providers can be equitably assessed relative to others? What outcomes do consumers value, and how can this information be fed into decision-making? Again, consistent and flexible transactions/encounter level data on services is needed to support such studies, and the data have to include, if they are to be useful, those population- and provider-based variables needed for adjustment or manipulation.

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