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Invited Commentary
May 9, 2019

Condition-Specific Standard Sets of Outcome Measures Critical for Clinical and Health Services Research

Author Affiliations
  • 1Duke Children’s Hospital, Durham, North Carolina
  • 2Duke University School of Medicine, Durham, North Carolina
JAMA Facial Plast Surg. 2019;21(5):359-360. doi:10.1001/jamafacial.2019.0229

When you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind. It may be the beginning of knowledge, but you have scarcely, in your thoughts, advanced to the stage of science.

William Thomson, Baron of Kelvin, Electrical Units of Measurement (1883)

If you cannot measure it, you cannot improve it. Such is the pithy maxim attributed to Irish physicist and engineer William Thomson, Baron of Kelvin. In medicine, this concept was applied to quality improvement by Armenian physician Avedis Donabedian, who described a constant interplay among 3 levels of a health care system: structure (eg, health care setting, personnel, and facilities), process (eg, treatment choices or delivery methods), and outcomes.1 Donabedian proposed that close scrutiny of each level would reveal opportunities for intervention that may improve outcomes. Donabedian’s model shares much in common with robust quality improvement methods in manufacturing (eg, Lean, Six Sigma, and the Toyota Way) and forms the foundation of more recent health care–specific quality improvement paradigms (eg, Institute for Healthcare Improvement’s Model for Improvement and the Triple Aim).