Emphasizing Methods in Outcomes Research

Abstract

O utcomes research focuses on the end results of health care, with emphasis on the patient experience. The field is not a singular discipline, but rather draws on a broad range of primary fields to produce knowledge that can inform decisions at the patient and health system level. Outcomes research uses a wide spectrum of methods that include experimental and nonexperimental designs. It is distinctive in its focus on questions that are relevant to optimizing efforts to promote the health of patients and populations, with an emphasis on aligning decisions to the preferences, values and goals of those individuals.The richness of methodological approaches to outcomes research is apparent in the pages of Circulation: Cardiovascular Quality and Outcomes. Examples include articles that report on randomized trials, 1,2 cross-sectional studies, 3 observational cohort studies, 4 economic analyses, 5-7 meta-analyses, 8 systematic reviews, 9,10 prepost designs, 11 simulations, 12 and qualitative research. 13,14 A glance at this content quickly dispels the myth that outcomes research is primarily associated with secondary data analyses and data mining. That type of work, for the appropriate questions and with the appropriate methodological approach, can make important contributions, but is hardly the only study design used by the field. Moreover, even studies using existing data bases often exhibit novelty in their methodological approach. 15 At Circulation: Cardiovascular Quality and Outcomes, our commitment to advancing clinical research methods is supported by our process of manuscript evaluation. The statistical review process is conducted, in collaboration with the editors, by a talented team that is directed by Dr Sharon-Lise Normand, our Senior Statistical Consultant, with the assistance of her Associate Statistical Consultants, Drs. Yulei He (Harvard), Armando Teixeira-Pinto (University of Porto), and M. Alan Brookhart (University of North Carolina, Chapel Hill). Each manuscript is independently assessed by an expert in statistics and methods. These individuals, who generously devote time to the journal, have particular skill in the methods of outcomes research and a sensitivity to the goals of the field; their reviews are among the most insightful and incisive that we see. Their perspective complements that of the main reviewers who are also often quite skilled in, and provide assessment of, a submission's methodological qualities. Although involving a statistical reviewer represents an additional layer of evaluation that can increase review time, we consider it essential. The statistical review almost always elevates the quality of contributions to the high level expected for publication in Circulation: Cardiovascular Quality and Outcomes.There are other ways that we seek to promote the importance of methods. We welcome opportunities to debate methodological approaches through respectful dialogue about the strengths and weakness of analyses and study designs. In some cases, published original articles have focused...