Sozialmedizinische aspekte der ergebnisqualität

Presently health services re-searches debate on whether to concentrate on process or outcomes measures when assessing quality of care. Since process and outcomes are generally weakly related, especially in the field of rheumatology, outcomes measurement and research becomes indispensable, at least under the auspices of the "evidence-based medicine" movement (EBM). EBM seems to find "its purest application" in formulating and implementing indication rules and clinical guidelines. It is also relevant for estimating health care needs in populations. Need has been epidemiologically defined as "the population's ability to benefit" from health care interventions. Furthermore it provides a basis for assessing the appropriateness of both individual care and population coverage. Finally, it supports the process of priorisation. Rheumatology has a long and good tradition in defining and measuring patient-centred outcomes such as pain, disabil-ity and occupational handicaps. It was a rheumatic disease epidemiologist who developed WHO'S International Classification of Impairments, Disabilities and Handicaps. There are however still underdeveloped fields in the context of rheumatic patient's preferences and perceptions ("satisfaction"). Given that outcomes assessment is a prominent task of clinical rheumatology how should it be done? The article discusses shortly the advantages and disadvantages of measuring change "directly" by enquiring about patient's perceptions post hoc vs observing changes by comparing at least two measurements, one prior to, the others after an intervention.