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Outcomes/Effectiveness Research

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AHCPR's PORT projects have made substantial contributions to research and clinical practice, but more studies are needed

Beginning in 1989, the Agency for Health Care Policy and Research funded a set of ambitious research projects known as patient outcomes research teams (PORTs). These 14 projects were succeeded, starting in 1993, by a "second generation" of projects known as PORT-IIs. Together, AHCPR's PORTs and PORT-IIs represent a total investment of more than $100 million to answer critical questions about the effectiveness and cost-effectiveness of available treatments for common clinical conditions. A recent article by researchers from several PORTs, as well as Carolyn M. Clancy, M.D., Director of AHCPR's Center for Outcomes and Effectiveness Research, describes the purpose and accomplishments of the PORTs.

The PORTs were designed to take advantage of readily available data and to focus on common clinical conditions that are costly to the Medicare and Medicaid programs and for which there is regional variability in outcomes and use of resources. The PORTs are made up of a multidisciplinary team of researchers ranging from health economists and clinicians to quality-of-life experts and epidemiologists. PORT investigators were instructed to answer the following questions: What works and at what cost? For which patients or subgroups of patients? When? Why is there variation in the use of treatments? What can be done to reduce inappropriate variation? From whose perspective—i.e., the patient is the ultimate judge of effectiveness? Is there a potential for development and use of patient-reported outcome measures?

PORT researchers advanced the methods and applications of outcomes and effectiveness research, that is, the examination of the end results of medical interventions when applied to patients in everyday practice. Effectiveness studies often are designed to monitor patients over time, wherever they get their care, and to chart the outcomes of that care. PORT researchers use Medicare and Medicaid data and data from insurance claims and other large administrative databases to characterize patterns of care, develop general and disease-specific outcome measures, and disseminate important outcome information to patients and physicians to reduce inappropriate practice variation and improve outcomes.

The authors point out that although PORTs represent an essential start in defining and refining the methods for producing outcomes and effectiveness measures, additional research is needed. The PORTs were limited in several dimensions. First, the majority of PORTs focused on conditions found in adults 65 and older, meaning the problems of children and middle-aged adults were largely neglected. Second, the results of PORT studies cannot be generalized to populations other than those studied. For example, PORT findings cannot be used to determine whether and when to perform knee replacements or cataract surgery on people younger than 65. Third, certain population groups may have been understudied. For example, many of the PORTs looked at differences in conditions, performance rates, and outcomes for blacks, but there may not have been sufficient data to do the same for Hispanics, Asians, and other groups.

For more information, see "Patient outcomes research teams: Contribution to outcomes and effectiveness research," by Deborah Freund, Ph.D., Judith Lave, Ph.D., Dr. Clancy, and others, in the Annual Review of Public Health 20, pp. 337-359, 1999. Reprints (AHCPR Publication No. 99-R073) are available from the AHCPR Clearinghouse.

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