The outcomes of outcomes and effectiveness research: Impacts and lessons from the first decade

Objective. To assess the outcomes of the Agency for Healthcare Research and Quality's (AHRQ formerly the Agency for Health Care Policy and Research, A HCPR) first decade of focus on outcomes and effectiveness research (OER) an d to identify needs and opportunities for the study of OER in the coming ye ars. Data Source. Study findings were collected in response to an inquiry by the Center for Outcomes and Effectiveness Research at AHRQ in July 1997 to all principal investigators (PIs) funded between 1989 and 1997. The request wa s for investigators to identify their "most salient findings" and supply ma terial for up to three slides. Study Design. A taxonomy of 11 non-mutually exclusive categories was used t o group the investigators' salient findings by characteristics of methodolo gy or purpose. Two health services researchers assigned findings to up to t hree categories for each discrete study. Principal Findings. Responses were received from 61 (64 percent) of the 91 PIs, reporting on 115 studies. Of the 246 category assignments made, descri ptive epidemiology was the most common (24 percent), followed by comparativ e effectiveness (17 percent) and economic assessments (12 percent). Most st udies were retrospective analyses of administrative data. Viewed within a c onceptual framework for assessing the impact of research, OER has built a s olid foundation for future quality improvement efforts by identifying probl ems, generating hypotheses, and developing new methodologies and has had li mited impact on health care policies, practices and outcomes. Conclusions. OER has had moderate but significant success meeting initial e xpectations for the field. Challenges for the next generation of OER includ e advancing from hypothesis generation to definitive studies of effectivene ss, and acceleration of the process by which findings effect policy, practi ce, and outcomes.