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August 18, 1989, Vol 262, No. 7 >
ARTICLE | August 18, 1989

The Medical Outcomes Study: Title and subTitle BreakAn Application of Methods for Monitoring the Results of Medical Care FREE

Alvin R. Tarlov, MD; John E. Ware, Jr, PhD; Sheldon Greenfield, MD; Eugene C. Nelson, DSc; Edward Perrin, PhD; Michael Zubkoff, PhD
[+] Author Affiliations

The opinions expressed herein are those of the authors and do not necessarily reflect the opinions of the sponsors, participants, or other institutions involved.

Reprint requests to The Institute for the Improvement of Medical Care and Health, New England Medical Center, Box 345, 750 Washington St, Boston, MA 02111 (Dr Ware).


JAMA. 1989;262(7):925-930. doi:10.1001/jama.1989.03430070073033
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References

The Medical Outcomes Study was designed to (1) determine whether variations in patient outcomes are explained by differences in system of care, clinician specialty, and clinicians' technical and interpersonal styles and (2) develop more practical tools for the routine monitoring of patient outcomes in medical practice. Outcomes included clinical end points; physical, social, and role functioning in everyday living; patients' perceptions of their general health and well-being; and satisfaction with treatment. Populations of clinicians (n = 523) were randomly sampled from different health care settings in Boston, Mass; Chicago, Ill; and Los Angeles, Calif. In the cross-sectional study, adult patients (n = 22 462) evaluated their health status and treatment. A sample of these patients (n = 2349) with diabetes, hypertension, coronary heart disease, and/or depression were selected for the longitudinal study. Their hospitalizations and other treatments were monitored and they periodically reported outcomes of care. At the beginning and end of the longitudinal study, Medical Outcomes Study staff performed physical examinations and laboratory tests. Results will be reported serially, primarily in The Journal.

(JAMA. 1989;262:925-930)

REFERENCES

1 +
Stewart AL, Greenfield S, Hays RD, et al.  Functional status and well-being of patients with chronic conditions: results from the Medical Outcomes Study . JAMA. 1989;;262:907-913.
2 +
Wells KB, Stewart A, Hays RD, et al.  The functioning and well-being of depressed patients: results from the Medical Outcomes Study . JAMA. 1989;;262:914-919.
3 +
Donabedian A.  Evaluating the quality of medical care . Milbank Q. 1966;;44:166-203.
4 +
Donabedian A. The Definition of Quality and Approaches to Its Assessment . Ann Arbor, Mich: Health Administration Press; 1980;.
5 +
Brook RH, Davies-Avery A.  Quality assessment: issues of definition and measurement . In: Ertel PY, Aldridge MG, eds. Medical Peer Review: Theory and Practice . St Louis, Mo: CV Mosby Co; 1977;:111-131.
6 +
Manning WG, Leibowitz A, Goldberg GA, Rogers WH, Newhouse JP.  A controlled trial of the effect of a prepaid group practice on use of services . N Engl J Med. 1984;;310:1505-1510.
7 +
Epstein AM, Hartley RM, Charlton JR.  A comparison of ambulatory test ordering for hypertensive patients in the United States and England . JAMA. 1984;;252:1723-1726.
8 +
Yellin EH, Hencke CJ, Kramer JS, Nevitt MC, Shearn M, Epstein WV.  A comparison of the treatment of rheumatoid arthritis in health maintenance organizations and fee-for-service practices . N Engl J Med. 1985;;312:962-967.
9 +
Brook RH, Ware JE, Rogers WH, et al.  Does free care improve adults' health? Results from a randomized controlled trial . N Engl J Med. 1983;;309:1426-1434.
10 +
Ware JE, Brook RH, Rogers WH, et al.  Comparison of health outcomes at a health maintenance organisation with those of fee-for-service care . Lancet . 1986;;1:1017-1022.
11 +
Croog SH, Levine S, Testa MA, et al.  The effects of antihypertensive therapy on quality of life . N Engl J Med. 1986;;314:1657-1664.
12 +
Davies AR, Ware JE, Brook RH, Peterson JR, Newhouse JP.  Consumers' acceptance of prepaid and fee-for-service medical care: results from a randomized controlled trial . Health Serv Res. 1986;;21:429-452.
13 +
Fowler FJ Jr, Wennberg JE, Timothy RP, Barry MJ, Mulley AG Jr, Hanley D.  Symptom status and quality of life following prostatectomy . JAMA . 1988;;259:3018-3022.
14 +
Barry MJ, Mulley AG Jr, Fowler FJ Jr, Wennberg JE.  Watchful waiting vs immediate transurethral resection for symptomatic prostatism: the importance of patients' preferences . JAMA . 1988;;259:3010-3017.
15 +
Rogers WH, Berry S, McGlynn E, et al. The Medical Outcomes Study Implementation: Sampling Methods, Data Collection, and Respondent Characteristics . Santa Monica, Calif: The RAND Corp. In press.
16 +
Kessner DM, Kalk CE. A Strategy for Evaluating Health Services . Washington, DC: Institute of Medicine; 1973;:6.
17 +
Wells K. Depression as a Tracer Condition in the National Study of Medical Care Outcomes: Background Review . Santa Monica, Calif: The RAND Corp; 1985;. Publication R-3293-RWJF/ HJKFF.
18 +
Burnam MA, Wells KB, Leake B, Landsverk J.  Development of a brief screening instrument for detecting depressive disorders . Med Care . 1988;;26:775-789.
19 +
Wells KB, Burnam MA, Leake B, Robins LN.  Agreement between face-to-face and telephone-administered versions of the depression section of the NIMH Diagnostic Interview Schedule . JPsychiatr Res. 1988;;22:207-220.
20 +
Burnam MA, Wells KB. Use of a Two-Stage Procedure to Identify Depression: The Medical Outcomes Study . Washington, DC: National Institute of Mental Health. In press.
21 +
Ellwood PM.  Outcomes management: a technology of patient experience . N Engl J Med. 1988;;318:1549-1556.
22 +
Roper WL, Winkenwerder W, Hackbarth GM, Krakauer H.  Effectiveness in health care: an initiative to evaluate and improve medical practice . N Engl J Med. 1988;;319:1197-1202.
23 +
Relman AS.  Assessment and accountability: the third revolution in medical care . N Engl J Med. 1988;;319:1220-1222.
24 +
Keeler EB, Brook RH, Goldberg GA, Kamberg CJ, Newhouse JP.  How free care reduced hypertension in the Health Insurance Experiment . JAMA . 1985;;254:1926-1931.
25 +
Nelson E, Wasson J, Kirk A, et al.  Assessment of function in routine clinical practice: description of the COOP chart method and preliminary findings . J Chronic Dis. 1987;;40:15S-63S.
26 +
Stewart AL, RD Hays, Ware JE.  The MOS short-form general health survey: reliability and validity in a patient population . Med Care. 1988;; 26:724-735.
27 +
McDermott W.  Absence of indicators of the influence of physicians on a society's health . Am J Med. 1981;;70:833-843.
28 +
Nelson E, Conger B, Douglass R, et al.  Functional health status levels of primary care patients . JAMA . 1983;;249:3331-3338.
29 +
Health and Public Policy Committee, American College of Physicians.  Comprehensive functional assessment for elderly patients . Ann Intern Med. 1988;;109:70-72.

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1 +
Stewart AL, Greenfield S, Hays RD, et al.  Functional status and well-being of patients with chronic conditions: results from the Medical Outcomes Study . JAMA. 1989;;262:907-913.
2 +
Wells KB, Stewart A, Hays RD, et al.  The functioning and well-being of depressed patients: results from the Medical Outcomes Study . JAMA. 1989;;262:914-919.
3 +
Donabedian A.  Evaluating the quality of medical care . Milbank Q. 1966;;44:166-203.
4 +
Donabedian A. The Definition of Quality and Approaches to Its Assessment . Ann Arbor, Mich: Health Administration Press; 1980;.
5 +
Brook RH, Davies-Avery A.  Quality assessment: issues of definition and measurement . In: Ertel PY, Aldridge MG, eds. Medical Peer Review: Theory and Practice . St Louis, Mo: CV Mosby Co; 1977;:111-131.
6 +
Manning WG, Leibowitz A, Goldberg GA, Rogers WH, Newhouse JP.  A controlled trial of the effect of a prepaid group practice on use of services . N Engl J Med. 1984;;310:1505-1510.
7 +
Epstein AM, Hartley RM, Charlton JR.  A comparison of ambulatory test ordering for hypertensive patients in the United States and England . JAMA. 1984;;252:1723-1726.
8 +
Yellin EH, Hencke CJ, Kramer JS, Nevitt MC, Shearn M, Epstein WV.  A comparison of the treatment of rheumatoid arthritis in health maintenance organizations and fee-for-service practices . N Engl J Med. 1985;;312:962-967.
9 +
Brook RH, Ware JE, Rogers WH, et al.  Does free care improve adults' health? Results from a randomized controlled trial . N Engl J Med. 1983;;309:1426-1434.
10 +
Ware JE, Brook RH, Rogers WH, et al.  Comparison of health outcomes at a health maintenance organisation with those of fee-for-service care . Lancet . 1986;;1:1017-1022.
11 +
Croog SH, Levine S, Testa MA, et al.  The effects of antihypertensive therapy on quality of life . N Engl J Med. 1986;;314:1657-1664.
12 +
Davies AR, Ware JE, Brook RH, Peterson JR, Newhouse JP.  Consumers' acceptance of prepaid and fee-for-service medical care: results from a randomized controlled trial . Health Serv Res. 1986;;21:429-452.
13 +
Fowler FJ Jr, Wennberg JE, Timothy RP, Barry MJ, Mulley AG Jr, Hanley D.  Symptom status and quality of life following prostatectomy . JAMA . 1988;;259:3018-3022.
14 +
Barry MJ, Mulley AG Jr, Fowler FJ Jr, Wennberg JE.  Watchful waiting vs immediate transurethral resection for symptomatic prostatism: the importance of patients' preferences . JAMA . 1988;;259:3010-3017.
15 +
Rogers WH, Berry S, McGlynn E, et al. The Medical Outcomes Study Implementation: Sampling Methods, Data Collection, and Respondent Characteristics . Santa Monica, Calif: The RAND Corp. In press.
16 +
Kessner DM, Kalk CE. A Strategy for Evaluating Health Services . Washington, DC: Institute of Medicine; 1973;:6.
17 +
Wells K. Depression as a Tracer Condition in the National Study of Medical Care Outcomes: Background Review . Santa Monica, Calif: The RAND Corp; 1985;. Publication R-3293-RWJF/ HJKFF.
18 +
Burnam MA, Wells KB, Leake B, Landsverk J.  Development of a brief screening instrument for detecting depressive disorders . Med Care . 1988;;26:775-789.
19 +
Wells KB, Burnam MA, Leake B, Robins LN.  Agreement between face-to-face and telephone-administered versions of the depression section of the NIMH Diagnostic Interview Schedule . JPsychiatr Res. 1988;;22:207-220.
20 +
Burnam MA, Wells KB. Use of a Two-Stage Procedure to Identify Depression: The Medical Outcomes Study . Washington, DC: National Institute of Mental Health. In press.
21 +
Ellwood PM.  Outcomes management: a technology of patient experience . N Engl J Med. 1988;;318:1549-1556.
22 +
Roper WL, Winkenwerder W, Hackbarth GM, Krakauer H.  Effectiveness in health care: an initiative to evaluate and improve medical practice . N Engl J Med. 1988;;319:1197-1202.
23 +
Relman AS.  Assessment and accountability: the third revolution in medical care . N Engl J Med. 1988;;319:1220-1222.
24 +
Keeler EB, Brook RH, Goldberg GA, Kamberg CJ, Newhouse JP.  How free care reduced hypertension in the Health Insurance Experiment . JAMA . 1985;;254:1926-1931.
25 +
Nelson E, Wasson J, Kirk A, et al.  Assessment of function in routine clinical practice: description of the COOP chart method and preliminary findings . J Chronic Dis. 1987;;40:15S-63S.
26 +
Stewart AL, RD Hays, Ware JE.  The MOS short-form general health survey: reliability and validity in a patient population . Med Care. 1988;; 26:724-735.
27 +
McDermott W.  Absence of indicators of the influence of physicians on a society's health . Am J Med. 1981;;70:833-843.
28 +
Nelson E, Conger B, Douglass R, et al.  Functional health status levels of primary care patients . JAMA . 1983;;249:3331-3338.
29 +
Health and Public Policy Committee, American College of Physicians.  Comprehensive functional assessment for elderly patients . Ann Intern Med. 1988;;109:70-72.

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