Epidemiology and the health care revolution.
OBJECTIVE
Revolutions in the health care marketplace, with their implied dependence upon the population perspective, have renewed interest in epidemiologic methods and their application.


METHODS
As a way of organizing questions, data, and answers, epidemiology is once again the core scientific discipline for a multidimensional paradigm shift that emphasizes five facets of health care. First, the health of enrolled populations, rather than merely treatment of sick individuals presenting for care. Second, assessment of the "time, place, and person" of disease burden--who is healthy, who is not, and what it will take to maximize their health. Third, the causative factors for disease and the factors or characteristics that promote health. Fourth, the development of evidence-based clinical guidelines for clinicians and consumers alike. Fifth, evaluation of the impact providers are having on the health of populations (outcomes), individually and collectively.


RESULTS
Thoughtful consideration of all of the above factors depends upon epidemiologic data and insights brought to a firm and conclusive end point capable of supporting policy.


CONCLUSIONS
Credibility will require that epidemiologists (and the symbiotic media) exercise far greater restraint in drawing definitive conclusions and speculations from often starting but meager data.
Sommer
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Office of the Dean, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205-2179, USA.
D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000639:trends*; D004813:Epidemiology; D018166:Health Care Reform; D006801:Humans; D017063:Outcome Assessment, Health Care