Outcomes, Outcomes Research and Disease Management: A View from the UK
The UK National Health Service (NHS) is in the process of further reforms aimed at restoring a national focus to its activities and also at enhancing the quality of the service it provides. Key features are: 1. the formation of primary care groups to replace general practitioner (GP) fundholders, holding a single devolved budget for the majority of NHS services 2. a move towards defining outcome and performance indicators for the NHS 3. the establishment of new bodies to develop and monitor the implementation of clinical guidelines 4. the evaluation of new technologies including pharmaceuticals; and 5. a new framework termed `clinical governance' for the long term maintenance of quality. This approach to quality and outcomes may start to move the NHS away from its focus on processes, but in the short term at least, the ability to make this change is limited by the performance indicators available. Many of these indicators are process markers rather than true outcomes, but given the poor outcomes data currently collected by the NHS, it may be all that is possible for the moment. The commitment to better quality in the NHS may make underfunding of the NHS more obvious and lead to further political difficulties for the government. Disease management systems which have in-built markers of their quality, both in terms of the service provided and its outcomes, may look increasingly attractive to the NHS. Outcomes research in the NHS will remain clinically focused for the moment but, with the explicit consideration of cost effectiveness underlying clinical guidelines in the future, a gradual move to the US type of outcomes research is possible in the future.
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