Patient-centered outcomes composites: a glimpse of the future.

T he field of medicine is rushing headlong into a new, information-intensive era of practice and research. As medicine learns to wield the tools of " big data, " there is growing confidence that physicians and researchers will be able to obtain, measure, and analyze information from multiple sources, including the directly solicited views and preferences of patients. In this week's issue of Circulation, Stolker and colleagues 1 provide insight into where this major trend may be headed. Using a simple questionnaire administered to patients in a cardiovascular clinic, they uncovered several intriguing findings. First, they noted a difference between clinical trialists and patients in terms of the importance ascribed by each group to preventing different specific outcomes that make up the classic major adverse cardiovascular event end points used to assess the safety and efficacy of cardiovascular therapies. Second, they found that among the patient respondents to their survey, these weightings also varied as a function of demographic factors. From these findings, Stolker and colleagues propose that weighted composites could be used to personalize evidence assessment to inform healthcare delivery on the basis of these differences. The measurement of patient preferences has a long history that nevertheless seems to undergo perpetual rediscovery. Yet the key issues in this arena have received scant attention from funding agencies, and very little support has been directed toward research aimed at elucidating patient preferences and decision-making processes. As a result of this inattention, many decisions at the individual, population, and policy levels are made without a true understanding of the preferences of either the downstream decision makers (doctors, other providers , and administrators) or the patients and caregivers who will be affected. By demonstrating that different people may have notably divergent interpretations of the import of clinical trial results, Stolker and colleagues have made a significant contribution to our emerging understanding of patient-centered approaches to medicine. The cognitive and social aspects of decision making have enjoyed intensive scrutiny in the field of behavioral economics , and business schools have long focused on preferences and choices. The present work is limited by the methods that were available, but the direction of the findings points to major areas ripe for exploration. To their credit, Stolker and colleagues surveyed the relevant population: patients in a cardiovascular clinic. However, it is well understood that the framing of questions is of critical importance in survey-based research. The very …