The deman for measurenment of outcomes was the result of many factors, including the lack

of outcomes studies, the need for quantifiable data concering health care, and variations
within medical practice,. There is significant variation, based on geographical area, in
medical tratment ( Wennberg, 1990). Significant variation in treatment has also been
documented based on the care provider involved. Client question why such differences exist,
including why some providers would not perfom less invasive and less costly procedures
even though they may be just as effective as the more invasive and costly procedures.

The absence of outcomes studies documenting effectiveness of many nursing care

interventions also has led to the demand for outcomes studies. Outcomes studies provide
information on which to base decisions about the most effective interventions. The study of
client outcomes in light of nursing interventions differs from the controlled environment of
research studies. Nursing outcomes studies are conducted in the client care setting since that
is where the interventions and outcomes occur. Nursing outcomes studies can provide
answers question such as teh following:

1. In order to best manage client symptoms which nursing treatment will be most
productive?
2. Will clients be better prepared for diagnostic test following an existing or proposal
protocol?
3. Following surgery, which methood for teaching client and families about
postoperative care will be the most effective?
4. To achieve the most effective clinical and dinancial outcomes, which clinical pathway
should be followed?

Outcomes studies also are being demanded by employers who provide health benefits for
their employees. The eployers wnat to know about not only the costs of the care that is
provided but also the client outcomes derived from that payment. The absence of outcomes
studies in the past means that it is not yet clear axactly what the consuments expectation are
where quality of care is concerred. Just as outcomes need to be studied, it will be necessary to
study the type of quality information that consumers need to make informed healthcare
decisions, how the presentation of that information can influence their decisions, and how
consumers interpret the information provided to them. It is clear, however, that both
employers and consumers expect the highest possible quality for the lowest possible cost. In
order to substantiate nursing contributions to high quality and low cost, reliable data must be
obtained ( Cleary & Edgman Levitan, 1997; Oermann & Huber, 1999)