Careers in cardiovascular outcomes research.

To best understand the field and goals of outcomes research, it is important to appreciate the challenges that confront our healthcare system. Although considerable advances in patient care have been made over the last several decades, patients, physicians, and payers continue to struggle with rising costs and inefficiencies, poor application of evidence to clinical care, fragmentation, misaligned incentives, disparities, suboptimal patient safety, and lack of patient-centeredness. In its seminal 2001 report, Crossing the Quality Chasm: A New Health System for the Twenty-first Century, the Institute of Medicine concluded that the US healthcare system has fallen far short of its potential to deliver care in a safe, timely, equitable, efficient, evidence-based or patient-centered manner.1 They called for a complete redesign of the way in which we currently practice and deliver care. The field of outcomes research is ideally positioned to address most of these challenges. Outcomes research focuses on what is ultimately achieved by our efforts in healthcare. It seeks not only to describe the “end-result of healthcare” (patient outcomes) and its determinants but also to develop solutions to improve the outcomes by aligning the needs of patients with the performance of physicians and the healthcare system with the use of available resources.2,3 The field of outcomes research ranges from everyday clinical decision making that affects individual physicians and patients to population science, health economics, and policy. As such, outcomes research lies at the interface of multiple scientific disciplines, including clinical epidemiology, biostatistics, qualitative research, behavioral science, organizational theory, ethics, decision analysis, health system economics, health policy, health informatics, and the sciences of quality improvement and implementation research. Understanding and integrating these multiple disciplines can accelerate the pace and application of insights into practice. Therefore, to be a successful outcomes researcher, one should ultimately be contributing toward the process of improving clinical care. Although the full cycle of improvement requires multiple stages and participants, a prospective investigator must be able to identify critical issues in patient care and health policy, crystallize these issues and possible solutions, study the identified components of care, summarize and disseminate the findings, and then contribute toward the implementation of potential solutions, often studying the impact of these novel approaches to care. An outcomes researcher is often first an astute clinician who can appreciate the subtleties and nuances of patient care but also someone who can subsequently measure and analyze these aspects of care, interpret the results so that opportunities for improvement may be gleaned, and develop and test interventions that can affect patient outcomes in a meaningful way. The need for a national focus on outcomes research is great. Because cardiovascular disease is the leading cause of death4 and healthcare costs5 for men and women in the United States, the field of cardiology has a particularly pressing need to advance the field of outcomes research. A critical initial step in this direction is to expand the infrastructure for training cardiovascular outcomes researchers.