Defining the outcome phase

Outcome is defined in the Concise Oxford Dictionary as ‘a result, a visible effect’. This sense that an outcome is the final step of a sequence of events is reinforced by the synonyms given for outcome in the Oxford Thesaurus, as shown in Table 9.1.

Outcomes are generally considered to be changes in functioning, in morbidity or in mortality (Thornicroft & Tansella, 1996). These outcomes are attributable to the treatment and care received, which themselves can be analysed as input and process variables. Outcomes are therefore a complex product of multiple influences, and they can be considered at the three geographical levels of the matrix model (Figure 9.1 shows such possible outcomes). The difficulties associated with defining and collecting outcomes data have meant that input and process variables have often been used as proxies for outcomes, a categorical error (Jenkins et al., 1994).

Outcome can be considered from two points of view.The first is the broad definition, which refers to changes in any variable, for example a politician may describe an increase in investment in mental health services (input) as a favourable outcome. Similarly, a service re-reorganisation, following a monitoring exercise, may lead to an increase in the average frequency of out-patient contacts with patients (process), which the patients and clinicians may see as a positive outcome.Second, the narrow definition refers only to the health status of an individual patient, or of aggregations of individual patient data, and implies measures taken at least at two time points, before and after a clinical intervention. In this chapter we shall deal with ‘outcome’ in terms of the second, narrow definition.