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Dear Arthur Perhaps you already visited the following link to AHRQ which gives a good and tacit explanation of "outcomes" research. http://www.ahrq.gov/clinic/outfact.htm http://www.ahrq.gov/clinic/out2res/outcom1.htm also one example of outcomes research here http://content.nejm.org/cgi/content/full/358/12/1229 Now, I understand that you could see any study considering an important outcome for the patient as an "outcome research"; but we should also pay attention to the evidence and its quality: high, moderate, low or very low. And if based on this evidence the guideline panel could give a final recommendation: strong in favor, weak in favor, weak against, or strong against X procedure, intervention or exposure. In your trial/example of the surgeon with procedure X, the quality of evidence would be very low (observational study with no control group) and if you should give a recommendation based on only this evidence, it would be a weak recommendation (for or against the procedure), and again, all depends on the outcome important to the patient, clinician, stakeholders, etc Not all strong recommendations come from high quality evidence, consider the example of epinephrine for cardiac arrest or anaphilactic shock (only observational studies at most or animal studies) where most clinicians would still recommend it and use it in the emergency departments. I would recommend using the GRADE system here. Best wishes -- Carlos A. Cuello-García, MD Director, Centre for Evidence-Based Practice-Tecnologico de Monterrey Cochrane-ITESM coordinator. Professor of Paediatrics and Clinical Research Avda. Morones Prieto 3000 pte. Col. Doctores. CITES 3er. piso,Monterrey NL, México. CP64710 Phone. +52(81)88882154 & 2141. Fax: +52(81)88882019 www.cmbe.net The content of this data transmission must not be considered an offer, proposal, understanding or agreement unless it is confirmed in a document signed by a legal representative of ITESM. The content of this data transmission is confidential and is intended to be delivered only to the addressees. Therefore, it shall not be distributed and/or disclosed through any means without the authorization of the original sender. If you are not the addressee, you are forbidden from using it, either totally or partially, for any purpose