Outcome research - a task also for osteology - demonstrated by the example of osteoporosis

Outcome research is a new task for medical research It does not define himself by specific methods but by specific questions concerning the need of quality (process, results) and of improvement in the everyday medical care. It is focused on the effectiveness (outcome) of the methods of patient care, and by that connected with the difficulties to translate principles into action and with the close link between efficacy (absolute effectiveness in the controlled clinical trail) and effectiveness (relative effectiveness under everyday conditions) narrowly. The difference between these two represents the effectiveness- or performance-gap. To measure this performance-gap is the main topic of outcome research. In clinical practice of osteoporosis the international structure of outcome research, such as input - throughput - output - outcome", corresponds to "the specialist of osteoporosis - osteoporosis practice and guidelines - osteoporosis therapy - reduced fracture incidence and improved quality of life". These components apply on diagnostic and on therapeutic processes. Documentation of the medical everyday practice represents the basis of outcome research. Today data bases of payment invoices are preferably used for outcome research. But they show less exactly the medical care situation of the patient and can contain administrative or monetary biases. The examples of the BONE-EVA-Study, of the REAL-study and the General Pratitioner-data-base-analysis of GB to the steroid induced osteoporosis demonstrate the various characteristics of the data bases for osteoporosis. Outcome research creates new possibilities of evaluating the efficiency of diagnostic methods and therapeutic strategies, also for the osteoporosis. A main task of the outcome research of osteoporosis is the extensive and intensive implementation of the diagnostic anti therapeutic recommendations of the DVO guidelines into the practice, and the evaluation of their practical efficiency. From this it will be possible to develop national disease management guidelines.