Chapter 7: Developing a Question

INTRODUCTION

Performing outcome measurement begins with identifying a meaningful and answerable question. Once the question has been determined, the inputs and processes related to the outcome of interest are identified. In this chapter, the origins of outcome questions are described, and sample questions about clinical practice are organized using the Model of Rehabilitation Service Delivery and evidence-based practice strategies.

IDENTIFY AN OUTCOME OF INTEREST

The first step in any outcome study is to identify the outcome of interest. The choice might be based on interesting clinical observations, an issue raised in the literature, a question from someone about an aspect of practice, or a management concern. It is more meaningful to study an aspect of practice that is important or pressing. The process of outcome measurement requires a long-term commitment, so the chosen question and outcome should hold the clinician’s interest over time, and the answer should be useful in practice.

In some way, the chosen outcome should be related to improving patient services. Whether at the level of the individual patient or at broader level of service delivery to many patients, the purpose of outcome measurement is to influence service provision. This focus on improving services is one of the key differences between outcome research and other types of research. In basic science, or “bench,” research, discovery for the sake of identifying a new entity or relationship is purpose enough. In contrast, outcome research is conducted specifically to improve the quality of services provided. If a link between the question, the possible answers, and managerial or clinical strategies is not clear, then the question may not be suitable for an outcome study.

Outcome studies have different origination points. A study might begin with a request from a hospital administrator to determine patient satisfaction with services in a clinical setting. In this example, the starting point is at the outcome portion of the model; that is, patient satisfaction is a type of patient outcome. The inputs in this study might include all outpatients served during a particular month, and the process might be limited to patients who received only direct services, but the inputs and processes are determined after the outcome is identified.

An outcome study can examine a process. Suppose a manager wanted to review the quality of documentation in a clinical setting. In this type of a study, the input characteristics and ...