HEALTH OUTCOMES

The term "health outcomes" describes the consequences of an encounter between a patient and the health care system, and is generally accepted to mean the end result of an episode of illness or injury that has been treated. The potential range of unsatisfactory outcomes have been alliteratively identified as "death, disease, disability, disruption, discomfort, and dissatisfaction." Of course, another possible outcome is complete and full recovery with joy and happiness all around. Both positive and negative outcomes can be identified (most of them easily and objectively), counted, and classified, thereby facilitating the evaluation of health care systems and services.

It is important for health care providers and facilities to take action to address unsatisfactory health outcomes. Death, when it is untimely or untoward, especially if it is attributable to a medical misadventure or mistake, is an unmistakable indicator of shortcomings in the health care system. Disease, in this context, signifies complications or adverse effects of diagnostic and therapeutic interventions, such as hospital-acquired infections, blood clots associated with immobilization in bed, and innumerable other mishaps great and small. Disability refers to permanent or long-term consequences of the encounter between a patient and the health care system, again a very diverse range of possibilities. Disruption means incapacity to resume previously customary activities at work or home. Discomfort can be assessed through patient reports of symptoms such as pain and sleeplessness, and it can be measured by the need for analgesics, sleeping pills, and other medications. Dissatisfaction is revealed by responses to direct questions, and can be unobtrusively assessed by such means as failure to return for scheduled appointments and aftercare. In a well-run health care system all these outcome indicators are assessed and recorded, and action is taken to remedy shortcomings as they are detected.

John M. Last

(see also: Administration of Public Health Services; Hospital Administration )