Dear listmembers
Randomised studies are supposed to provide the most robust & believable
answers to 'what works' - unfortunately in many areas, they tell us
little about what works in the 'real world', since they are generally
about 'efficacy', rather than 'effectiveness'. Making trials more
'pragmatic' (more representative participants, less rigid entry
criteria, real world treatment alternatives), whilst maintaining
randomisation seems to be the logical response - though progress has
been slow in this respect.
However, our North American colleagues seem keen on 'outcomes research'
to determine the 'real world clinical and cost effectiveness' of all
manner of treatments, interventions, policy initiatives etc. My
understanding of 'outcomes research' is that this is a specific
observational research design which harnesses routinely collected
outcomes from large claims databases and adjusts for baseline and case
mix variables to determine real world effectiveness.
i am looking for further information and examples of this design, since
it is not well covered in traditional epidemiology texts. I would be
grateful if members of the list could point me in the direction of:
1. Key examples of 'outcomes research' which have provided answers
which might not otherwise have been available from randomised data.
2. Specific examples of problems with this design.
3. Any examples of 'outcomes research' in my own area of specialty -
MENTAL HEALTH/PSYCHIATRY.
please respond to me directly, unless you feel this topic justifies
debate on the discussion list. i will be happy to summarise any replies
and feed this back.
with many thanks in advance
simon gilbody
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Simon Gilbody
MRC Fellow in Health Services Research/Specialist Registrar in
Psychiatry
NHS Centre for Reviews and Dissemination
University of York
YO1 5DD
UK
http://www.york.ac.uk/inst/crd/
tel +44 (0)1904 433710
fax +44 (0)1904 433661
e-mail [log in to unmask]
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