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The ‘Global Outcomes Score’: A Quality Measure, Based on Health Outcomes, That Compares Current Care to a Target Level of Care
Study Questions:
How may the global outcomes (GO) score—a measure of clinical effectiveness that is based on a predicted risk of health outcomes according to the provision of varying levels of care—be applied to describing the effectiveness of hypertension and cholesterol management?
Methods:
This was a theoretical study used to illustrate the use of the GO score. The GO score was used to measure the quality of care being delivered to the patients in the ARIC (Atherosclerosis Risk in Communities) study, conducted from 1987 to 1998. “Target level of care” was defined as 100% adherence to treatment guidelines in the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol (ATP III). “Current care” was defined as the level of care at the start of the study (i.e., before implementation of guidelines). The GO score was calculated as the current risk reduction divided by the target risk reduction.
Results:
The level of care being delivered at the start of the ARIC study was 40% as effective in preventing myocardial infarctions and strokes as the target level of care (i.e., the standard of care at the time vs. complete adherence to guidelines).
Conclusions:
The GO score may be useful in framing and assessing the effectiveness of different interventions, including adherence to guidelines.
Perspective:
The authors present a novel measure—the GO score—which takes into account multiple variables that impact patient-level outcomes. While the concept of ‘no care,’ ‘current care,’ and ‘target care’ are novel, it is unclear how easily the GO score could be applied into routine clinical practice and what the incremental value would be. Although there may be a role for calculating the anticipated net benefit of new prospective programs or guidelines, countless studies continue to demonstrate low levels of adherence to guideline-based care. Before developing novel measures of clinical effectiveness like the GO, we ought not to lose sight of the pursuit of putting guidelines into practice and understanding barriers to adherence to evidence-based care.
Keywords: Outcome Assessment, Health Care, Stroke, Myocardial Infarction, Atherosclerosis, Risk Reduction Behavior, Standard of Care, Cholesterol, Quality of Health Care, Guideline Adherence, Cardiovascular Diseases, Patient Compliance, Hypertension
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