Measuring outcomes with tools of proven feasibility and utility: The example of a patient-focused asthma measure

Best quality care is clearly desirable and instituting quality assurance should be logical and simple. However, the practicality of setting standards for a product or service, and designing systems to measure against the standards, is more difficult. In the health service it is only likely to be feasible if data can be generated from efficient and reliable information systems. The ideal measure of quality is an outcome measure that evaluates whether or not the quality of care has achieved the desired standard of outcome. Direct measures of outcome are not easy to construct and the information systems required to provide data are not widely available. The National Centre for Health Outcomes Development (NCHOD) has produced a series of indicators in 10 areas of health care, where an indicator is a pointer to, rather than a direct measure of, a desired outcome. Feasibility studies measuring their sensitivity and reliability have drawn attention to their possible utility within different health care settings. This paper reports on an investigation into a patient-focused outcome indicator for asthma. There is broad agreement about the need to measure the outcome of disease. However, when outcome indicators are defined there are major obstacles to their successful uptake. A key challenge for outcomes measurement is to ensure that the cost of collecting the data and ensuring completeness, accuracy and standardization are justified by the benefits derived. Health outcome indicators should not be treated as a panacea, but as a part of the clinical and health care tool kit.