Outcomes Research and Epidemiology

Abstract

Outcomes research was defined in 1998 as “the study of the end results of health services that takes patients' experiences, preferences, and values into account … intended to provide scientific evidence relating to decisions made by all who participate in health care.”1 Inherent to this definition is the fact that outcomes research is multidisciplinary and relies on diverse domains of expertise, with an explicit goal of direct relevance to the care delivered to patients. Within this multidisciplinary framework, epidemiology is one of the disciplines related to the field of outcomes research. Epidemiology is the study of distribution and determinants of disease frequency in human populations, with a particular focus on the occurrence of disease as categorized by time, place, and persons.2 Sometimes referred to as the basic science in medicine,3,4 epidemiology is founded on principles and methods (including methods of statistical analysis) that form the basis of clinical research.3,4 The fundamental constructs that epidemiology embraces are key to the conduct of outcomes research today. Indeed, envisioning the burden of disease through the lenses of the traditional epidemiological constructs of time and person can provide powerful guidance to shape the direction of outcomes research and assess its impact. This Editor's Perspective shares a few examples to illustrate this point. In a Shattuck Lecture published in the New England Journal of Medicine , Eugene Braunwald5 designated heart failure as a new epidemic of cardiovascular disease. This eloquent statement generated thought-provoking questions: Was there, indeed, an epidemic of heart failure in the epidemiological sense of the word? If so, is the epidemic driven by increase in incidence, improvement in survival, or both? These questions inspired epidemiologists to conduct the needed formal investigation of the heart failure epidemic, which meant bringing to bear rigorous epidemiological …