Measuring success in the treatment of children in the emergency department setting: process versus outcomes?

The current best design practices for clinical studies require consideration of the assessment of end points that combine key processes and outcomes. Process assessment measures events in the pathway on which a more important intermediate or ultimate health outcome depends. Process assessment can be either formative or summative. Outcomes assessment relates to identifying the results related to a process, and is most often defined as the change in a patient's current or future health state. The development of process and outcomes measures for any study is difficult, and children and emergency department settings present unique sets of issues worth highlighting. This article presents an overview of issues relating to choice of process and outcomes measures in studies of pediatric emergency medicine. Asthma care is used to illustrate the complex issues surrounding the measurement of success in management in the emergency department setting.