The Outcomes of Cancer Outcomes Research: focusing on the National Cancer Institute's quality-of-care initiative.
BACKGROUND
To assess the impact of outcomes research, the Agency for Healthcare Policy and Research has proposed a four-level typology that successively distinguishes between research that (1) adds to the knowledge base only, (2) affects practice policies, (3) influences the delivery of care, and (4) leads to changes in health outcomes. The agency has concluded that outcomes research to date has made substantial contributions at level 1, but has had little impact at levels 2 to 4.


OBJECTIVE
To describe the National Cancer Institute's emerging agenda in cancer outcomes research, focusing on how it has been shaped early on to support the institute's quality of care initiative and noting whether each new project represents outcomes research at level 1, 2, 3, or 4.


RESULTS
Cancer outcomes research describes, interprets, and predicts the impact of various influences, especially (but not exclusively) interventions on endpoints that matter to decision makers. The institute's projects to improve the scientific quality of final endpoint measures, strengthen the methodologic and empirical basis for quality of care analysis, and enhance the application of health-related quality-of-life measures in clinical trials represent level 1 applications of outcomes research. Collaborative projects with federal agencies to translate evidence into practice and a new public and private effort to identify core measures of cancer quality represent level 2 and level 3 outcomes research.


CONCLUSIONS
The stage has been set for carrying out a balanced portfolio of level 1 to 3 outcomes research projects in cancer, with the ultimate (level 4) aim of improving cancer-related health outcomes.
Lipscomb
Joseph
J
Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7344, USA.
Snyder
Claire F
CF
D002986:Clinical Trials as Topic; D006279:Health Maintenance Organizations; D006291:Health Policy; D006801:Humans; D007373:Interinstitutional Relations; D009316:National Institutes of Health (U.S.); D009369:Neoplasms; D017063:Outcome Assessment, Health Care / Q000145:classification*; D017149:Private Sector; D017150:Public Sector; D012107:Research Design; D018426:SEER Program; D014481:United States; D016270:United States Agency for Healthcare Research and Quality